Health Coverage in Elderly Adults The words Medicare and Medicaid are very similar, and the differences confuse many people. To make matters worse, the two are government programs and the two help pay for health care. But that is where the similarities end; Medicare and Medicaid are two completely different programs. The main difference is that Medicare is usually for the elderly or disabled, and Medicaid is for people with limited incomes and resources. Medicare is available without regard to your income or net worth while Medicaid is a “means tested” program (i.e., you have to meet certain financial requirements). If you live in New Jersey a good Medicaid planning attorney Toms River can help you know which of the two programs you may qualify for. Medicaid is a joint federal and state program, administered by state governments, that helps pay for health care costs for certain individuals and families with limited income and resources. An elder lawyer Toms River can help you because, within the framework of Medicaid, different programs are offered for specific populations. Each state creates its own Medicaid programs, following federal rules. With Medicaid, there are mandatory benefits and optional benefits. Mandatory benefits include, in part: • Care and services received in a hospital or skilled nursing facility. • Care and services received at a federally qualified health facility, a rural health clinic, or an autonomous birth center (licensed or recognized by your state). • Services of a physician, nurse midwife and nurse practitioner certified in family and pediatric medicine. The costs depend on your income and the rules of your state. Costs may include insurance premiums, deductibles, copays, and coinsurance. Certain groups are exempt from most out-ofpocket expenses. This is where a good Medicaid planning attorney in Toms River (if you live in the State of New Jersey), can advise you. The Medicaid administrative agency in New Jersey establishes the following as requirements to be a beneficiary of the program: • In general, to receive the benefits of this program, you must be a United State citizen, legal alien or permanent resident, and you must have a low income. • You must also be a resident of the state of New Jersey. • To qualify you must also have an annual family income (before taxes) less than the following amounts: People in household Maximum income (annual) 1 2 3 4 5 6 7 8
$15,800 $21,307 $26,813 $32,319 $37,825 $43,331 $48,851 $54,384
For households with more than eight people, add $ 5,533 per additional person. A good elder lawyer Toms River can advise you on this matter. For long-term care programs, your monthly gross income cannot exceed $2,205 (2017) nor can your non-exempt assets exceed $2,000 (single) or $3,000 (married). Even if your income is over the $2,205 per month threshold, a qualified income trust (a/k/a Miller Trust) may be available to help you qualify. Another aspect not related to the elderly but that is good to mention has to do with pregnant women who are covered by Medicaid for all care related to pregnancy, childbirth, and complications that may occur during pregnancy and up to 60 days after birth. In addition, pregnant women may also qualify for the care they receive during their pregnancy before they apply and the Medicaid benefit is tightened. Some states call this "Presumptive Eligibility" and are put in place for all women to begin necessary prenatal care as early as possible in pregnancy. For a free consultation with our medicaid planning attorney Toms River call 732-784-2846