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What Is the Difference Between Medicare and Medicaid in New York

One aspect of growing older and moving through retirement is determining how you will pay for healthcare. While you are working, you likely have health insurance from your employer. Once you reach 65 and retire, you may apply for Medicare and Medicaid. These government-run programs can help you afford healthcare as you age.

The services covered by these two programs overlap, so you may not need to apply for both. The most significant difference is that Medicaid pays for a broader range of long-term health care. Medicare Part A pays for medically necessary hospital treatment, skilled nursing home, skilled home health, and hospice care.

However, Medicare doesn’t include personal services like dressing or feeding since they aren’t “skilled.” Thus, it’s essential to explore the question, What is the difference between Medicare and Medicaid in New York? If you know what to expect, you can get ready to get the coverage you need before you need it.
If you have any questions, don’t hesitate to contact the Law Offices of Andrew M. Lamkin, P.C. today.

What Is Medicare?

Medicare is a federally funded national health insurance program. It provides health insurance for Americans 65 or older or with specific disabilities. The program has four parts that provide different types of coverage, including:

  • Part A—hospital insurance (includes short-term skilled nursing facilities, hospice care, and some home health care);
  • Part B—medical insurance (includes doctor’s visits, services outside of a hospital, home health care, durable medical equipment, and limited prescription drugs);
  • Part C—Medicare advantage plans (bundles Part A and Part B services with prescription drugs and other services); and
  • Part D—prescription drugs (covers prescription drugs not covered in Part B).

Parts A and B are referred to as “original medicare.” You can add Part D coverage if you need it or choose a Part C bundled plan instead. Additionally, if you need help paying for your coinsurance, copayments, and deductibles, you may apply for Medicare Supplement (Medigap) insurance. Private insurers provide Medigap insurance for those who already have Medicare Part A and B. You can also use Medigap coverage to access additional benefits like skilled nursing facility coinsurance and foreign travel emergency care. 

You must sign up for Medicare when you are eligible, or you will face a penalty. If you’re still working after you turn 65, you can choose to keep your insurance through your employer. However, once you stop working or lose your health insurance, it’s important to sign up for Medicare to avoid the penalty. 

Qualifying for Medicare

Most people qualify for Medicare when they turn 65. You can enroll in Medicare Part A and B when registering for Social Security benefits. If you are not ready to receive Social Security benefits, you can enroll in Medicare coverage only. Most people are eligible to enroll for free Part A coverage because they have worked and paid Medicare taxes. However, there is a monthly premium with Part B. The government covers up to 75% of the premium for most applicants. Those with higher incomes can pay up to 85% of the cost. Part D coverage, Medicare advantage plans, and Medigap plans are offered by private insurers. You may add these plans through the Medicare Plan Finder or directly on the plan’s website.

It’s important to enroll during your Initial Enrollment Period (IEP), or you will pay a late fee. The usual IEP opens three months before your 65th birthday, includes that month, and closes three months afterward. If you’re still working, you can enroll during a special enrollment period that lasts eight months after you stop working.

What Is Medicaid?

Medicaid is a state-run program that helps low-income people pay for health care costs. It is regulated by the federal government. NY Medicaid covers the costs of doctor’s visits, hospital stays, vision, dental, and prescription drugs. It can also help those over 65 pay for long-term care, like a home health aide or nursing home care—services not covered by Medicare. Additionally, if you have Medicare and qualify for full Medicaid coverage, you can get help paying your Medicare Part B premium, deductibles, coinsurance, and copayments. However, because Medicaid is a needs-based program, you must meet the income requirements to qualify.

Qualifying for Medicaid

When applying for Medicaid at age 65 or older, you will apply through your Local Department of Social Service (LDSS) as a Non-MAGI Eligibility Group. To be eligible for Medicaid, you must have income and assets (resources) below the threshold level. For 2022, your income must fall below $11,200 per year for a single person or $16,400 for a two-person household. Your assets (resources) include cash, bank accounts, life insurance policies, stocks, bonds, mutual fund shares, promissory notes, and real property. A single person’s assets cannot exceed $16,800, and a two-person household is limited to $24,600. 

If you are applying for nursing home benefits, the LDSS “looks back” at your income in the five years prior. However, you have options if your income or resources exceed these levels. You can participate in a “spenddown program,” where you get help paying your medical bills but pay your excess income as a deductible. You can also work with an attorney in anticipation of needing Medicaid assistance to transfer your assets to be eligible for coverage.

The Law Offices of Andrew M. Lamkin P.C.: Helping New Yorkers Qualify for Medicaid and Medicare

If you’re searching for the answer to the question, What is the difference between Medicare and Medicaid in New York? search no more. The Law Offices of Andrew M. Lamkin has been helping New Yorkers navigate the complexities of Medicaid and Medicare since 2007. Our practice focuses on elder law, estate planning, and other areas of law that affect you as you grow older. Don’t wait to plan for the future. Our experienced and knowledgeable Medicaid attorneys can create a strategy to protect your assets and qualify for healthcare benefits when you need them. When it’s time to get care, we will work with the home health agency or nursing home to assist in a stress-free transition. With our help, you can obtain the maximum benefits, so you don’t have to worry about the costs of healthcare or caring for your family. Contact us today.

Author Photo

Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.

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