Medicare vs. Medicaid: What Seniors Need to Know

Navigating the complex world of healthcare and long-term care can be overwhelming for seniors and their families. Two key government programs—Medicare and Medicaid—serve as essential lifelines, but many seniors and their families struggle to understand the differences between them, the eligibility requirements, and how to use them effectively.

At SAMUELS WOOD PLLC, we aim to provide clarity on these important programs, helping you make informed decisions about your healthcare and long-term care options. In this blog, we’ll explore the key differences between Medicare and Medicaid, the eligibility criteria for each, and tips on how to navigate both programs for maximum benefit.

What Is Medicare?

Medicare is a federal health insurance program designed for seniors aged 65 and older, as well as certain younger individuals with disabilities. Medicare primarily covers medical services and supplies, but it does not typically cover long-term care or custodial care. Understanding the different parts of Medicare is key to ensuring you’re getting the right coverage:

Medicare Part A: Hospital Insurance

• Covers: Inpatient hospital stays, skilled nursing facility care (short-term rehab stay), hospice care, and some home health services.
• Eligibility: Most people qualify for Medicare Part A without having to pay a premium if they or their spouse paid Medicare taxes while working.

Medicare Part B: Medical Insurance

• Covers: Outpatient care, doctor visits, preventive services, and some home health services.
• Eligibility: Part B requires a monthly premium, which is typically deducted from Social Security payments.

Medicare Part C: Medicare Advantage

• Covers: Combines the benefits of Part A and Part B, and may include additional benefits like vision, dental, and prescription drug coverage.
• Eligibility: Must be enrolled in both Part A and Part B to qualify. Plans are offered by private insurance companies approved by Medicare.

Medicare Part D: Prescription Drug Coverage

• Covers: Assistance with prescription medications
• Eligibility: Available to anyone enrolled in Part A or Part B, with a monthly premium.

What Medicare Doesn’t Cover:

While Medicare provides valuable coverage, it does not cover long-term care at home, assisted living facility and/or at a skilled nursing facility, most dental and vision services, hearing aids, etc. This means that if a senior needs long-term care, such as a nursing home care, assisted living, or assistance with daily activities at home, they may need to turn to other options like Medicaid or private long-term care insurance.

What Is Medicaid?

Medicaid is a joint federal and state program that provides healthcare coverage for low-income individuals, including seniors. Unlike Medicare, Medicaid is designed to assist with long-term care, and eligibility is primarily based on financial need, age, and/or disability. Medicaid can cover a broader range of services, including nursing home care and even some types of home and community-based care. Medicaid is state specific regarding eligibility.

What Medicaid Covers:

• Long-Term Care: Medicaid covers nursing home care, assisted living, and in some cases, home and community-based services.
• Medical Services: Medicaid also covers a wide range of medical services, including doctor visits, hospital stays, prescriptions, lab tests, and more.

Medicaid Eligibility:

Medicaid eligibility depends on your age or disability, income, and assets.  Please note these limits can vary by state. In general, to qualify for Medicaid, seniors must have:

• Age: 65 or older.  If younger than 65, the applicant must be shown to be disabled – either by SSA or Medicaid determination.
• Income: Your income must fall below a certain threshold, which varies by state and program. For 2025, the income cap is $2,901 for a single applicant.
• Assets: Medicaid has strict asset limits. For example, individuals are typically allowed to have no more than $2,000 in countable assets, though there are exceptions for things like a homestead property, a car, and certain other assets.
• State-Specific Rules: Because Medicaid is administered at the state level, the specific rules and eligibility requirements may differ from one state to another.

How to Navigate Medicare and Medicaid Together

Many seniors qualify for both Medicare and Medicaid, especially those with limited income or who need long-term care. When a senior is eligible for both programs, this is referred to as “dual eligibility.” In this case, Medicare typically serves as the primary insurance for hospital and outpatient care, while Medicaid covers additional services, such as long-term care.

Understanding the differences between Medicare and Medicaid is essential for seniors and their families to make informed healthcare decisions. Medicare is an important resource for hospital and medical services, while Medicaid is critical for covering long-term care and supporting low-income individuals. If you or a loved one are navigating both programs, it’s important to understand your eligibility, what each program covers, and how to make the most of both options.

If you need assistance with Medicare or Medicaid planning, eligibility questions, or long-term care options, don’t hesitate to reach out to us at (561) 864-3371 or www.samuelswood.com. Navigating Medicare and Medicaid can be tricky, but you don’t have to do it alone. Contact SAMUELS WOOD PLLC today to discuss your situation and get the help you need!