What is the difference between Medicare and Medicaid? How do I go about applying for my aging parent?

Medicare is health insurance for the following:

  • People 65 or older
  • People under 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (ESRD) who are receiving dialysis treatments and also people who have a diagnosis of HIV/AIDS.

Medicare has four different parts that help cover different services. They are:

  • Medicare Part A (Hospital Insurance)
    • Helps cover inpatient care in hospitals, skilled nursing facilities, hospice, and home health care.
    • Most people don’t have to pay a premium for Medicare Part A because they or a spouse paid Medicare taxes while working in the United States. If you don’t automatically get premium-free Part A, you may still be able to enroll, and pay a premium.
  • Medicare Part B (Medical Insurance)
    • Helps cover doctors’ and other health care providers’ services, outpatient care, durable medical equipment, and home health care.
    • Helps cover some preventive services.
    • Most people pay up to the standard monthly Medicare Part B premium which is $99.90. Although, higher-income consumers may pay more.
  • Medicare Part C (AKA Medicare Advantage Plans which are offered by private companies approved by Medicare)
    • Offers health plan options run by Medicare-approved private insurance companies. Medicare Advantage Plans are a way to get the benefits and services covered under Part A and Part B. Most Medicare Advantage Plans cover Medicare prescription drug coverage (Part D).
  • Medicare Part D (Medicare Prescription Drug Coverage)
    • Helps cover the cost of prescription drugs
    • May help lower your prescription drug costs and help protect against higher costs
    • Run by Medicare-approved private insurance companies
    • Costs and benefits vary by plan

Medicaid is a joint Federal and State program that helps to cover medical costs for some people with limited incomes and resources. Most health care costs, including prescription drug coverage are covered if you have Medicare and Medicaid. Medicaid programs vary from state to state.

  • Even if you aren’t sure whether you qualify, if your income is limited, and if you or someone in your family needs health care, you should apply for Medicaid and have a qualified caseworker in your state look at your situation.
  • People with Medicaid who are disabled or elderly may also get coverage for services such as nursing home care, home-based services, community-based services, food stamps and energy assistance.

For more information, visit www.socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office. If you have questions about Medicare, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).

Signing up for Medicare Part A and Part B

  • Some people get Part A and Part B automatically:
    • In most cases, if you are already receiving benefits from Social Security or the Railroad Retirement Board (RRB) you will automatically receive Part A and Part B starting the first day of the month in which you turn 65.
    • If you are under 65 and disabled you will automatically receive Part A and Part B after you receive disability benefits from Social Security or certain disability benefits from the RRB for 24 months.
    • If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease) you will automatically receive Part A and Part B the month your disability benefits begin. This is also true for people with ESRD receiving dialysis.
  • Some people need to sign up for Part A and Part B
    • If you are close to 65, but not getting Social Security or Railroad Retirement Board (RRB) benefits and you want Part A or Part B, you will need to sign up. Contact Social Security 3 months before you turn 65.
    • Initial Enrollment Period:
      • You can sign up when you’re fist eligible for Part A and/or Part B during you Initial Enrollment Period. For example, if you’re eligible when you turn 65, you can sign up during the 7 month period that begins 3 months before the month you turn 65, including the month you turn 65, and ends 3 months after the month you turn 65.
    • General Enrollment Period:
      • If you didn’t sign up for Part A and/or Part B when you first were eligible, you can sign up between January 1–March 31 each year. Your coverage will begin July 1 and you may have to pay a higher premium for late enrollment.
    • Special Enrollment Period:
      • If you’re covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B any time as long as you or your spouse (or family member if you’re disabled) is working, and you’re covered by a group health plan through the employer or union based on that work.
      • You also have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first.

Signing up for Medicaid

  • Every state has varying qualifications regarding the application to receive Medicaid benefits. To receive information on your state’s Medicaid application process please contact your State Medical Assistance (Medicaid) office.

How do I know the correct level of care my parent or spouse requires?

Senior living is categorized by the specific needs of the client. The options include independent living, assisted living or personal care homes, and skilled nursing.

There are tools available that allow you to complete a needs assessment on your loved one. Categories for assessment include:

  • Assistance level required for activities of daily living (ADLs)
  • Bathing, dressing, grooming, etc.
  • Assistance level required for instrumental activates of daily living (IADLs)
  • Using the telephone, transportation, preparing meals, etc.
  • Level that certain conditions affect the ability to function
  • Hearing, vision, perception, memory, strength, etc.
  • Environmental barriers that pose a threat
  • Neighborhood safety, condition of living quarters, stairs, furnishing, lighting, kitchen, bathroom, etc.

Other aspects to consider include: mobility, nutrition, mental status, communication, medications, finances, and activity.

Most facilities offer an on-site assessment to evaluate the level of care needed by your loved one.

Senior living options defined:
Independent living facility– is an age-segregated facility where healthy, mobile seniors live on their own with minimum assistance.

Assisted living facility or personal care home– is a type of facility that allows for independence, but provides individualized personal care and health services for people who require assistance with activities of daily living (ADLs).

Skilled nursing facility – is a specially qualified facility which has the staff and equipment to provide skilled nursing care or rehabilitation services, and related health services.

What should I look for when touring a prospective community?

You should always be conscious of the personal preferences of your loved one, including privacy, food, and other personal habits; this should be the primary concern. The idea is to make them as comfortable as possible in a safe and nurturing environment. It is a good idea to ask current residents what they think of the facility. This will be an excellent indicator of the overall satisfaction level of the residents. Also, ask around the neighborhood, you will be sure to receive candid responses on the residence.

Aspects to be aware of when touring a prospective community include:

Atmosphere – Does the residence appeal to you and your loved one? Does the staff regard you warmly? Do the other residents appear happy and content in their surroundings? Are visits to the residence welcome at any time?

Physical features – Is the residence designed for my loved ones needs? Are there accommodations for wheelchairs and walkers? Is there adequate lighting? Does the facility appear clean and at an appropriate temperature? Does the residence meet all local and state regulations?

Needs assessment, contracts, costs, and finances – Are resident needs assessed with input from family? Will long-term care cover any of the costs of care? Are there varying costs with different levels of care?

Medications and health care – Are there policies regarding storage of medication, staff training, and record keeping on medication?

Services – Are the staff available 24 hours a day? Are there housekeeping, transportation, pharmacy and or therapy services available?

Individual features – Are there different types of rooms offered? Are the bathrooms private or common? Are the rooms furnished? Is there a kitchen provided?

Social and recreational activities – Is there an organized activity program? Are there out of the facility activities? Can family members participate in the activities?

Food service – How many meals are provided per day? Is there a common dinning area?

Residence Directors and Managers – Was he or she friendly and cooperative? Did they possess good communication skills? Can you see yourself dealing with these individuals regarding your loved ones care?

Be sure to inquire about the most recent health inspection report, fire safety inspection report, staffing rates, quality measures, and stars received by the facility on the CMS quality rating criteria. You can compare facilities based on the CMS quality criteria at the following website: http://www.medicare.gov/quality-care-finder/index.html

How can my parents maintain their Jewish identity once they enter a nursing home or retirement community?

Residents should have a proactive approach when seeking religious services although facilities are very sensitive to their resident’s needs and expectations regarding their religion and culture. It is their duty to provide these services to all residents in order to fulfill their spiritual needs.

Facilities may offer in-house pastoral care services. If you do not wish to use these services or they are not offered, the in-house social workers/case managers should be contacted in order to facilitate the fulfillment of your loved one’s spiritual needs.

If your loved one will be entering a Jewish organization, religious and cultural needs are sure to be fulfilled. Most Jewish facilities offer an in-house Rabbi, Kosher meals, and daily, weekly and holiday services to fulfill your loved one’s spiritual needs.

How can I find community based services for seniors in my community?

Below you will find several useful contacts to find senior services in your local community, they include:

Administration on Aging (AoA) – AoA works to ensure the continuation of aging services networks at State, Territory, local and Tribal levels through funding of lower-cost, non-medical services and supports that provide the means by which many more seniors can maintain their independence. http://www.aoa.gov/.

Area Agency on Aging (AAA) – Created by the Federal Older Americans Act, AAAs represent a nationwide network of over 600 program sites. They are the focal point for aging concerns at the community level. Services include information and referral, case management, nutrition, employment, in-home services, counseling, legal services, senior employment, home repair, Pre-admission screening to nursing homes and day health care with an emphasis on ease of access.

Where available, each state links to a long-term care resource database maintained by that state for its Aging and Disability Resource Center (ADRC). ADRCs serve as single points of entry into the long-term supports and services system for older adults and people with disabilities.

The Eldercare Locator provides information and links to resources that enable older persons to live independently in their communities. This public service website links to state and local Area Agencies on Aging and community-based organizations that serve older adults and their caregivers. https://eldercare.acl.gov.

Centers for Independent Living provide access to resources for people with disabilities that empower individuals to live independently in their communities. ILRU (Independent Living Research Utilization) provides a national database of centers for independent living, and statewide independent living councils. www.ilru.org/.

Meals on Wheels are programs that deliver meals to individuals at home who are unable to purchase or prepare their own meals. To locate a program in your area please visit https://www.mealsonwheelsamerica.org/.

Home Health Care is health care or supportive care provided in the patient’s home by healthcare professionals. These patients are typically home bound and require skilled services. To locate and or compare Home Health services please visit the CMS compare website at http://www.medicare.gov/HomeHealthCompare/search.aspx

Local Senior Centers / Agencies – found in your local yellow pages

Adult Days Serviceswww.nadsa.org

Children of Aging Parentshttps://www.acapcommunity.org/

National PACE Associationwww.npaonline.org/

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