What is the Difference Between Medicare & Medicaid?

Medicare:

Insurance program with a monthly premium paid by the individual.

Medicaid:

Social service program run by the State of Washington and supplemented by the federal government. It is an entitlement program that can help certain individuals with specific needs pay for care services. The individual must meet very specific age, asset and income parameters.

Medicare

Medicare is a health insurance program designed for:

  • People age 65 or older.
  • People under age 65 with certain disabilities.
  • People with end-stage renal disease (permanent kidney failure).

As a health insurance program, a monthly premium is paid by the consumer.

Medicare has two parts:

  • Part A Hospital Insurance
  • Part B Medical Insurance

There are also Medicare supplementary programs available for purchase.

Medicare Part A helps cover your medically necessary hospital stays, skilled nursing facility care (with very specific parameters), home health (with very specific parameters), hospice care and blood.

Medicare Part B helps cover your doctor's services and outpatient hospital care. It may cover other medical services.

Medicare coverage is highly complex and very specific. For an in-depth understanding of Medicare, please go to http://www.medicare.gov or call Medicare at 1-800-633-4227 and request the booklet entitled "Medicare and You."

Medicaid

Medicaid is for individuals who have specific care needs and that meet very specific age, income and asset parameters. Medicaid is administered by the State of Washington. It is a program that is partially funded by the national government at present.

Medicaid may cover:

  • Care within a Skilled Nursing Facility.
  • Care within a Dementia Care community.
  • Care within an Adult Family Home.
  • In-Home Care.
  • Prescription drugs.
  • Medical care.

Links for More Information:

Please note: The following link primarily addresses care within a skilled nursing facility, but the information may be applicable to other types of care communities and services.
http://www.nwjustice.org/docs/5170.html

If you do not qualify for Medicaid, you may qualify for a Medically Needy Program:
http://www.nwjustice.org/docs/5104.html

To review the parameters of COPES (a Medicaid Program): COPES is designed for in-home care and care within Adult Family Homes
http://www.nwjustice.org/docs/5102.html#a

To apply for Medicaid in the State of Washington on-line:
https://wws2.wa.gov/dshs/onlinecso/abdmedical.asp

Or visit the DSHS website for a listing of Community Service Offices (CSO) in your area:
https://wws2.wa.gov/dshs/onlinecso/findservice.asp

To review which care communities or care options accept Medicaid or COPES, click on this link (Medicaid search) within the CHOICE Advisory website.

Qualifications & Applications for Medicaid

Qualifying for and applying for Medicaid can be a highly complex and demanding process. You may want to consider working with an Elder Law Attorney that specializes is Medicare Qualification and Application.

Review our database for Elder Law Attorney

If the person requiring Medicaid is currently in the hospital or in a skilled nursing facility, consider requesting an appointment with that facility's Social Services Department. They may be able to assist you with the process of applying for state assistance.

Some private case management agencies provide assistance with the process of Medicaid and/or COPES application. For a listing of private case management agencies click on this link. Private Case Management