Whereas both government-funded programs cover medical costs, eligibility for both depends on different criteria. While Medicare is typically reliant on age, Medicaid eligibility is dependent on income. If you currently have coverage through either or are seeking coverage, you may be confused regarding what items each program covers.

In this blog, our PA elder law legal team discusses the differences between both government-funded programs and the benefits of hiring an elder law attorney.

What is Medicare?

Medicare is a program for individuals 65 years of age and older, as well as younger people with disabilities. It is a fee-for-service federal program, with Original Medicare including Part A and Part B.

Part A covers the following services:

• Inpatient hospital care
• Skilled nursing facility (SNF) care
• Hospice care
• Home health care

Part B is medical insurance, covering the following services:

• Doctor and health care provider services
• Outpatient care
• Home health care
• Medical equipment (wheelchairs, walkers, and other hospital equipment)
• Many preventive services (wellness visits, shots, vaccines, and routine screenings)

Part D covers the cost of prescription drugs. When you join Medicare, you are given the option to sign up for Original Medicare or Medicare Advantage (known as Part C). If you sign up for Original Medicare, you will have Part A and B coverage. Under Original Medicare, you can join a Medicare drug plan to get prescription coverage.

If you have Medicare Advantage, you will be signing up for a Medicare-approved plan through a private company. While you will have similar coverage to Original Medicare, you will only be able to use doctors in the plan’s network. However, you may have extra benefits not under Original Medicare, including dental, vision, and hearing services.

What is Medicaid?

The eligibility for Medicaid differs between states but is generally income-based. Medicaid is a joint federal and state program that offers additional benefits that Medicare does not offer, such as nursing home care and other personal services.

In Pennsylvania, Medicaid services eligibility is available to the following groups:

• Children ages 18 and under
• Pregnant women
• Parents and caretakers of children under 21 years of age
• Adults between ages 19-64 with incomes at or below 133 percent of the Federal Income Poverty Guidelines
• Individuals seeking family planning services (pregnancy testing, contraceptive services, contraceptive counseling, birth control supplies, and other preventive services)
• Individuals 65 years of age and older
• Blind and disabled individuals
• Individuals receiving Medical Assistance for Workers with Disabilities (MAWD)
• Individuals receiving long-term care (LTC) or home and community-based services (HCBS)

In some states, including Pennsylvania, if you meet the resource limit but your income is too high, you may have the option to spend down your income. This spending can include Medicaid premiums and deductibles until you meet the income limit.

There are certain income limits for each specific group. For instance, the 2023-2024 modified adjusted gross income limit for a pregnant woman living in a three-person household is $4,455 per month.

Benefits of Hiring a PA Elder Law Lawyer

If your family member is in need of long-term care services, an elder law attorney can help in gathering the necessary documentation to enroll in Medicaid. In addition, a PA elder law attorney will advise your family member on the “look back” period to ensure that he or she meets income eligibility requirements. If Medicare is the best option for your loved one, then an attorney can offer guidance in choosing the right plan.

A PA Elder Law Attorney Ready to Provide Guidance

As we age, we are concerned about protecting our assets to give to our children. When you work with our PA elder law attorneys, our primary concern is getting you the care you need. We have years of experience helping our clients obtain affordable care while safeguarding their hard-earned money. If you are ready to get the process started, contact our legal team online