Medicare vs. Medicaid

People often confuse Medicare with Medicaid, which is understandable. The names are similar, and they are both government programs that help people with medical care. Some people are eligible for Medicare only. Others might be eligible for Medicaid only, and still others might be eligible for both programs. Medicaid vs. Medicare There…

Do You Know the Differences Between MediCARE and MediCAID?

People often confuse Medicare with Medicaid, which is understandable. The names are similar, and they are both government programs that help people with medical care. Some people are eligible only for Medicare, others only for Medicaid.  Some individuals might be eligible for both programs.

Type of Program

Medicare is a national medical insurance program, not an assistance program. You are only eligible for Medicare if you paid enough money into the program from the withholdings your employer took out of your paychecks for Social Security and Medicare taxes. Think of Medicare as health insurance that you pay for throughout your entire working life, but you do not start to access the benefits until you are 65. However, even then you continue paying monthly premiums, co-pays and deductibles.  Traditional Medicare benefits are consistent across the country, while Medicare Advantage plans may be region-specific (more on Advantage Plans later).

Medicaid is a medical assistance program for people with very low income.  There are a variety of Medicaid programs in each state, focused on the needs of specific populations.  Some of these populations include pregnant women, children, individuals who are legally blind, and persons who require nursing home. Depending on your income, you might have to pay a small co-pay, but there are no monthly premiums.  In Texas, Medicaid is not well-funded, so populations that are covered in other states are not covered here.

Texas Medicaid

Medicaid is a hybrid program that receives some of its funding from the federal government and some from each state. Since each state runs its own Medicaid program, every state’s variation of Medicaid is unique. It is important to understand the nuances of how Medicaid works in Texas.  Many people think that if they have already qualified for Medicaid in another state, they will be qualified in Texas, but they Medicaid benefits don’t cross state lines.  When someone moves to Texas they will lose their previous benefits, and have to apply for Texas Medicaid.


Some of the variety of Medicaid programs in Texas are targeted to: people with disabilities, pregnant women, families and children who meet the low-income guidelines, and older adults.  The asset and income thresholds for each program vary.  For Texas Nursing Home Medicaid, a single applicant can have no more than $2,000 in “countable resources”, and their monthly income can’t be more than $2,742.

To be eligible for Medicare, you must be at least 65 years old, (unless you have a disability), or have End Stage Renal Disease. Either you or your spouse must have worked for at least 10 years at a job that paid Medicare taxes to get Part A (hospital coverage), without having to pay a monthly premium. If the time worked was fewer than 10 years, you will pay a monthly premium for inpatient coverage (Part A).

There are some ways around having to pay the monthly premium for Medicare Part A. People with certain disabilities are exempted. If you are receiving or are eligible for Social Security or Railroad retirement benefits, you can also receive Part A premium-free.

Medicare does not care how much money you make for purposes of eligibility. However, having a high income can affect the premiums you pay for Part A or Part B (outpatient care). There is no upper limit to the amount of income you can have and still be eligible for Medicare. After all, you earned the right to get Medicare by paying Medicare taxes out of your paychecks for all those years.

Coverage Differences

Many people mistakenly think that Medicare covers long-term care.  Only Medicaid covers long-term nursing home care.

Traditional Medicare covers short-term rehabilitation in a skilled nursing facility after a qualifying hospital stay, but a copay is required after 20 days. Other Medicare benefits include physician visits, preventative care, hospitalization, prescriptions, and outpatient care.

Medicare Advantage plans are privately-managed health care insurance, similar to an HMO.  They have similar benefits to traditional Medicare, but offer some additional benefits in exchange for requiring pre-certification or pre-approval for most services.  Like Traditional Medicare, Medicare Advantage plans do not cover long-term care.

The program that does cover long-term care is Nursing Home Medicaid.  Texas also has a very limited program covering Assisted Living care, but it is not well funded and waiting lists are long.

Elder Law Attorneys Help Clients Qualify for Nursing Home Medicaid

There are several legal strategies that experienced Elder Law attorneys can use to help single or married individuals qualify and receive Nursing Home Medicaid.  If you or a loved one may need long-term nursing care sometime in the future, you should start to plan now.  Medicaid planning is complicated, and there are steep financial penalties if mistakes are made.  Don’t wait.  Book a call today.

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