Despite their similar-sounding names, Medicaid and Medicare are very different programs. To understand how these programs could factor into your future planning for someone with special needs, learn about Medicaid and Medicare functions and eligibility requirements.

Medicaid

Medicaid assists people of all ages who have lower incomes with paying medical expenses. For many covered expenses, Medicaid pays the entire cost directly to the health care provider. If Medicaid does not pay the entire cost, the recipient will make only a small co-payment. State and local governments run Medicaid using federal guidelines, unlike Medicare. Medicaid is always the secondary payer, so if an individual has private health insurance (for example, as a dependent on their parent’s health insurance), Medicaid can potentially pay for most of the out-of-pocket expenses that the health insurance doesn’t cover.

More importantly for many people with special needs, Medicaid pays for programs and services such as group homes and day programs as well as supported employment. Some Medicaid recipients are eligible for Medicare as well. These people can use their Medicaid assistance to pay for part of their Medicaid out-of-pocket costs.

Medicare

Medicare is a health insurance program run by the federal government and funded by trust funds that workers pay into from a portion of their paychecks. It helps recipients pay for health care costs such as hospital charges and home health care (Medicare Part A), doctor fees, lab costs, and outpatient care (Medicare Part B), and prescription drug coverage (Medicare Part D). Medicare does not cover all medical expenses, such as long-term care. 

Generally, people do not qualify for Medicare before they turn age 65.  However, an individual that receives SSDI will automatically receive Medicare after they have received SSDI for two years. Recipients must pay premiums, deductibles, and coinsurance as part of the program. States administer Medicare cost-sharing programs for people whose lower incomes prevent them from affording some or all Medicare costs.

Rubin Law is the only law firm in Illinois exclusively limited to providing compassionate special needs legal and future planning to guide our fellow Illinois families of children and adults with intellectual disabilities, developmental disabilities, or mental illness down the road to peace of mind. For more information, email us at email@rubinlaw.com or call 866-TO-RUBIN.