When people start to consider the need for government benefits, many clients become confused about the difference between Medi-Cal and Medicare. Which one do you need? Medi-Cal lawyers are more than capable of explaining the differences and advising you on which type of benefits you need, or which type you are eligible for.
What is Medicare?
Medicare is a federal health insurance program available for individuals who are age 65 and older, disabled, or dialysis patients. Unlike Medi-Cal, eligibility for Medicare is not based on need or income. Medicare recipients are only required to pay a portion of their medical expenses through deductibles. Also, small monthly premiums are necessary for non-hospital coverage.
How is Medicare different?
Medicare is different from Medi-Cal in that benefits are provided by private companies through contracts with Medicare. Since Medicare is solely run by the federal government, eligibility and benefits are the same all around the country.
Types of Medicare coverage
Medicare is divided into two basic types of coverage – Part A and Part B. Medicare Part A is an insurance plan for care in hospitals, skilled nursing facilities, home health care and hospice care. Medicare Part B, on the other hand, is more like basic medical insurance covering doctor visits, outpatient hospital care, and other medical services. Usually, recipients are not required to pay for Medicare Part A.
Who is eligible for Medicare?
In order to be eligible for Medicare, you must be age 65 or older, a U.S. citizen or permanent resident, and either you or your spouse must have worked for at least 10 years in a Medicare-covered job. Individuals who are younger than 65, but have a disability or End-Stage Renal disease requiring dialysis or a kidney transplant, may also qualify for Medicare. If you need more information about eligibility and benefits, you can visit www.Medicare.gov.
What is Medi-Cal?
One of the major differences between Medicare and Medi-Cal is that Medi-Cal is a needs-based or income-based health care assistance program. Federal, state and local tax funds are used to assist eligible individuals with paying their medical expenses. Typically, Medi-Cal recipients are only required to pay a small co-payment for covered medical expenses.
Medi-Cal is run by the state
Because Medi-Cal is run by the state and local governments, as opposed to the federal government (like Medicare), the requirements and available benefits will differ from one state to the next. Most states, however, provide coverage for eligible adults with children living below a certain income level, pregnant women, seniors and individuals with disabilities.
California’s Medi-Cal Program
California’s Medi-Cal program is known as Medi-Cal. This comprehensive program provides free or low-cost health coverage to California residents through 21 different managed care plans for. The coverage plans that are available may depend on which county you live in. California’s State-based Marketplace is called “Covered California.”
Do you have a Medi-Cal Plan?
It is never too late to start planning for the future need for Medi-Cal benefits. Planning ahead is the best option, especially with Medi-Cal’s 5-year look-back period meant to avoid fraudulent transfers of property. But, even if you find yourself suddenly needing to apply for Medi-Cal benefits there may still be options.
Why is Medi-Cal planning important?
Because Medi-Cal is a need-based assistance program in order to be eligible for Medi-Cal, you cannot have financial resources exceeding $2,000. The purpose of Medi-Cal planning is to prevent the need to exhaust all of your savings in order to qualify.
You can’t just give your property away
In 2005, a federal law was passed that imposes a period of ineligibility for anyone who transferred their assets within five years before applying for Medi-Cal. The five-year look back period starts when you submit your application. For that reason, the timing of your financial transactions in important and early Medi-Cal planning is key.
The penalty period applies only to those needing long-term care
Every applicant for Medi-Cal isn’t required to wait five years after transferring property before submitting their application. The penalty period is only applicable to those who need long-term care in an institutional setting, or who are receiving home health care. If you need acute care, such as hospital or physician services, you will remain eligible to receive benefits for those services, regardless of recent property transfers.
If you have questions regarding Medi-Cal, long-term care planning, or any other estate planning needs, please contact the Schomer Law Group either online or by calling us at (310) 337-7696. Join us for a free seminar!
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