When it is time for your family to consider whether a parent or other loved one needs nursing home or home health services, a question that often comes up is whether they will need government benefits to cover the costs. Primarily, what is the difference between Medicare and Medicaid, and what do these programs cover, in terms of home health services? Let our Los Angeles Medicaid attorneys answer some of these questions.
What you need to know about Medicaid
First, Medicaid is a government health care assistance program. Unlike Medicare, which is run by the federal government, Medicaid is run by the state. As a result, the eligibility requirements and benefits provided will be different depending on which state you live in. One thing that is true for all programs nationwide is that Medicaid eligibility is based on need or income. In most cases, Medicaid recipients are required to pay a small co-payment for covered medical expenses, if anything at all. Generally speaking, Medicaid provides coverage for eligible adults with children living below a certain income level, pregnant women, seniors and individuals with disabilities.
California’s Medicaid program is known as “Medi-Cal”
In California, the Medicaid program is referred to as Medi-Cal. This comprehensive program provides free or low-cost health coverage to California residents using 21 separate managed care plans. The specific plans that may be available to you will depend on the county in which you live. To get more information regarding eligibility and coverage, check out California’s Marketplace is called “Covered California.” If you still have questions about Medi-Cal coverage or eligibility, contact our Los Angeles Medicaid attorneys.
Basic information on Medicare
Medicare is a federal health insurance program available for individuals who are age 65 and older, disabled, or dialysis patients. Unlike Medicaid, eligibility for Medicare is not dependent on need or income. Instead, Medicare recipients are required to pay a portion of their medical expenses through deductibles, much like with private insurance. Small monthly premiums may also be required for non-hospital coverage.
How is Medicare different from Medicaid?
Medicare and Medicaid are different primarily on how they are run. With Medicare, benefits are provided through private companies that are under contract with Medicare to provide certain services. The other difference, as mentioned early, is that Medicaid is state-run. There is more uniformity with Medicare because it is run by the federal government. So, eligibility and benefits are basically the same nationwide.
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.
Medi-Cal Home Health Services
Medi-Cal provides coverage for home health services that are deemed medically necessary. This would include skilled nursing care and medical equipment. California also offers In-Home Supportive Services (IHSS), which includes ongoing, non-skilled care such as cooking, bathing, and housecleaning. The services provided through the IHSS program are not necessarily medical in nature, and can also include protective supervision for the mentally impaired and assistance attending medical appointments. One basic requirement is that the individual is unable to live at home safely without those services.
Medicare Home Health Services
The two primary Medicare programs, Part A (Hospital Insurance) and Part B (Medical Insurance) covers eligible home health services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational services, among other things. However, Medicare typically does not cover 24-hour-a-day at-home care, meal delivery, homemaker services, and personal care.
Who is eligible for home health services under Medicare?
Anyone who has Part A and/or Part B Medicare coverage and who is under the care of a doctor and receiving services under a plan of care established and reviewed regularly by a doctor may be eligible for these services. You must be certified by a doctor as being homebound. However, you are not eligible if you need more than intermittent or part-time skilled nursing care. Also, the home health agency providing your care must be Medicare-certified.
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