Medicare vs Medicaid

©Copyright 2009 Medicaid Information Resource, 3440 East Lake Rd, Suite 108,
Palm Harbor, FL 34685

MIR offers financial planning services designed to help elderly clients preserve their assets in safe investments so they may qualify for government financial assistance programs. MIR charges fees to assist elderly clients in submitting Medicaid applications, and we may receive commissions for annuities structured in the planning process. In 11 years filing Medicaid applications, we have never had an application denied.

We are not attorneys and do not offer legal advice or draft any legal documents. The decision to hire MIR is in no way equivalent to or a substitution for an attorney.

smiling faces Florida Medicare
Medicare is an entitlement-based Federal program that provides Medical insurance for the aged or disabled. While Medicare pays for expenses incurred in hospital stays, it can also assist with payments for up to 100 days in the nursing home if the individual meets certain requirements. Medicare can pay the entire cost for the first 20 days but the individual is required to pay a co-payment for the remaining 80 days. Many people have Supplemental Health Insurance policies which cover this co-payment that goes into effect after the 20th day. It is important to note that Medicare coverage does not necessarily remain in effect for the entire 100-day period. Medicare may stop paying at any time depending on the individual’s medical condition. If the person undergoing rehabilitation in the nursing home "plateaus" or reaches their full rehabilitation potential, Medicare coverage must stop. Since Medicare pays for only 100 days or less, only about 2 percent of nursing home expenses in the United States are covered by Medicare.

Medicaid Institutionalized Care Program (ICP)
Medicaid was originally designed to provide low-income persons with financial assistance to meet the costs of medical care and housing. Medicaid provides a variety of medically related assistance at reduced or no cost to those who qualify. There are many benefit programs which fall under the Medicaid umbrella, and each one has its own set of requirements to qualify for benefits. This website provides information dealing with the Florida Medicaid Institutional Care Program (ICP), commonly referred to as the Nursing Home Care Program.

Medicaid ICP is a government assistance program based on financial need. It provides qualified people with financial assistance to pay the cost of their nursing home care. ICP is jointly funded by the federal and state governments. Here in Florida, Medicaid is administered by the Department of Children and Families (DCF). Medicaid does not pay the entire cost of a person’s nursing home expenses. The person must contribute an amount based on his/her monthly income (Patient Responsibility) and then Medicaid pays the nursing home the approved rate for the facility.

For a single person living in Florida, Patient Responsibility is the person’s total gross income minus $35 for personal expenses, and any applicable health insurance premiums. For a married couple, calculating Patient Responsibility is a bit more complicated. Generally, if the well-spouse (community spouse) has a modest income, he/she is allowed to receive a portion of the institutionalized spouse’s income to help them maintain a reasonable standard of living.

There are two major financial requirements an applicant must pass in order to become eligible for Medicaid. The first test is the "Asset Requirement." If a person has too many assets they don't qualify. The second requirement is the "Income Requirement". Similarly, the applicant can only have so much income in order to qualify. The Medicaid applicant must meet both financial requirements in order to qualify for Medicaid benefits.