Differences Between Medicare and Medicaid in Florida

Medicare and Medicaid are two separate systems that help seniors and individuals with disabilities pay for health-related expenses. However, they do not serve the same purposes. Medicare is a federal health insurance entitlement program funded by Social Security tax contributions. Medicaid works as a needs-based program that varies from state to state and operates in partnership with the federal government.

Eligibility Criteria for Medicare and Medicaid

You can first sign up for Medicare three months before your 65th birthday, with your health coverage beginning once you turn 65.

You may be eligible for Medicare before turning 65 if you have:

  • A disability
  • End-Stage Renal Disease (ESRD)
  • ALS (also known as Lou Gehrig’s disease)

Medicare does not offer plans for couples or families.

Florida Medicaid requirements are:

  • Residing in Florida
  • Being a U.S. citizen, U.S. national permanent resident, or legal alien who needs health care and/or insurance
  • Have a low or very low income
  • Belong to one of those categories
    • At least 65 years of age
    • Pregnant
    • Be responsible for a child 18 years of age or younger
    • Blind
    • Have a disability or a family member in your household with a disability

How Does Medicare Work?

As a federal health insurance system, Medicare has the same application throughout the country. It has two primary components: hospital insurance (Part A) and medical insurance (Part B). You generally only need to sign up for those two components once.

You have the option to choose either:

  • Original Medicare: In addition to Parts A and B, you have the option to enroll in a separate drug coverage plan (Part D) and/or Medicare Supplement Insurance (Medigap) to lower some of your own expenses for the services you receive. You can go to any doctor or medical institution that accepts Medicare in the U.S.
  • Medicare Advantage: This bundle includes Part A, Part B, and generally Part D. You may also receive additional benefits for vision, hearing, and dental care. Medicare-approved private companies offer this type of coverage, and their exact rules, costs, and services may vary. You need to see medical providers who are in-network unless you need emergency or urgent care. You cannot buy supplemental coverage like Medigap.

Medicare does not pay for long-term care. However, this type of insurance can pay for up to 90 days of hospitalization once you have met your deductible. Depending on your coverage, Medicare can also pay for up to 100 days of rehab or nursing home care following a hospitalization that lasted at least three days.

With Medicare, you can receive skilled nursing care benefits for:

  • Up to 100 days per period of illness
  • No charge for the first 20 days
  • A daily co-pay for any additional day up to the authorized limit

If you receive insurance through another provider, like through your employer, one of the two providers is your primary payer and the other your secondary one.

What Can Medicaid Cover in Florida?

As a needs-based program, Medicaid requires a detailed assessment of your situation when you meet the eligibility criteria. Financial and medical needs are central to determining what services you may receive through Medicaid.

In Florida, Medicaid can offer financial coverage for skilled long-term nursing home care through its Institutional Care Program (ICP) and it also provides programs for assisted living facilities

Hire a Reputable Estate Planning Lawyer to Navigate Medicare and Medicaid Systems

At Dorcey Law Firm, our priority is to protect your future and our team has extensive experience with elder law. We can help you plan with both Medicare and Medicaid depending on your and/or your loved one’s needs. When you trust us with your legal needs, we carefully review your situation and make recommendations based on your specific goals.

Planning early can make a positive difference for you and your family. Being prepared offers you peace of mind and simplifies life transitions. From discussing what options fit your situation to helping you prepare and review the necessary paperwork; we can assist you at any step of the process.

Call Dorcey Law Firm today at (239) 309-2870 or use our online form to schedule a consultation to discuss your Medicare and Medicaid options in Fort Myers!