Medicaid and Medicare in Ohio Understanding Differences

“While most of those enrollees are seniors, there are many younger people

with permanent disabilities who are also in Medicare.”

Zimmer Law Firm, LLC (513) 721-1513 866.799.4050 (toll free) • ZimmerLawFirm.com

As of May 2014, there were 42 million people enrolled in Medicare. While most of those

enrollees are seniors, there are many younger people with permanent disabilities who

are also in Medicare.

Medicaid enrollment numbers are higher, partly because of the new healthcare laws. As

of April 2014, there were more than 61 million enrollees in this ever evolving program.

Over the course of a year - between June 2011 and June 2012 – 1.3 million people

enrolled in Medicaid for the first time. In April 2014 – just one month - there were 1.1

million people enrolled in Medicaid for the first time. Further, The Henry J. Kaiser

Foundation reports those numbers will continue to rise as the new healthcare laws fall

into place.

Each of these programs serve very important roles in society, but understanding the

differences between the two can be challenging.

Medicaid

Medicaid covers a

wide range of

medical needs.

Those in low income

homes, pregnant

mothers and of

course, some seniors,

benefit from this

medical assistance

program. There are

typically no co pays that a patient must cover.

In those states that opted to expand Medicaid funding as part of the Affordable Care

Act, those residents can qualify for this coverage if they do not earn enough to pay for

traditional insurance policies. This is one reason why the enrollment numbers are

exploding. If, however, a state opts not to expand coverage, those who wouldn’t have

qualified previously still won’t be able to secure Medicaid. About half of the states have

chosen to not expand their Medicaid programs.

Medicare

Medicare was signed into law in 1965. Its sole purpose was to provide healthcare

insurance for senior citizens. The program itself has evolved over the years and for

millions, Medicare helps bridge the gap for those on fixed incomes. A few of the

services Medicare covers include hospital stays, visits to the doctor and prescription

drug costs, depending on what type of coverage a recipient has.

Patients will sometimes be required to pay a deductible, but for most, it’s not a

problem.

Medicare also has four parts that have specific purposes for enrollees. For some, it can

be confusing to differentiate between mandatory and optional services.

Because Medicare is a federal program, the benefits are consistent, regardless of which

state one is in. By comparison, each state has its own parameters for Medicaid. While

some of the funding is from federal sources, because the states finance their respective

programs, the federal laws aren’t as specific as Medicare.

Medicare Parts A, B, C and D

Part A – Think of this as the Medicare foundation. It covers hospital stays, any lab work

you have done, surgeries and visits to your physician. It can also help cover the costs if

you need a wheelchair or other supplies. You’ll also want to speak with your healthcare

provider as she will be able to not only let you know what you don’t need, but also what

you may now need or will soon need. Your doctor is a great resource for your medical

questions and your estate planning lawyer is the resource that’s going to help you put

the legalities in place.

Part B – It may sound as though Parts A and B overlap each other in coverage, but there

are important distinctions. Part B will cover preventive services, which includes things

like flu shots. It also covers services and even supplies required to diagnose and possibly

treat any medical problems you have. The caveat is that the tests and treatments must

meet minimal medical practice standards. Part B will cover ambulance services, mental

health resources, research efforts that you may be participating in and it will even cover

the costs of getting a second opinion.

Part C – This Medicare part includes plans that outside parties may offer. This mirrors

HMO/PPOs that many have as part of their employment. Many say the coverage is

better, but remember that Part C is optional though are heavily regulated to ensure

consistency and value for patients similar to traditional Medicare coverage.

Part D – This is your prescription plan. It can play a significant role in how much you pay

in prescription drugs. The best part is it usually covers preventive drugs, as well. Again,

these are administered by third parties, so explore your options.

If you need guidance through either or both of these programs, we invite you to give us

a call. Our staff of experienced and compassionate estate planning lawyers stand ready

to ease the stressful burden from your shoulders.

About the Author

Barry Zimmer

Barry H. Zimmer founded THE ZIMMER LAW FIRM in June 1993, to practice in the areas of estate planning, estate administration, and business succession planning. His goal was and continues to be helping clients understand and de-mystify the often confusing world of estate planning in an ever-changing society, and to implement effective estate planning with minimal effort and time investment. The firm works from the belief that planning should always be driven by purpose. As a result, there are no “canned” or pre-set planning solutions. Instead, Zimmer helps clients identify their goals first and then builds estate and business plans based on that understanding. Barry has been in private practice since receiving his law degree from

the University of Cincinnati College of Law in 1979. He earned his Bachelor of Arts Degree from U.C. with Honors, Magna Cum Laude and Phi Beta Kappa, in 1976. He was profiled in the 1990-1991 edition of Who’s Who in American Law for contribution to the betterment of contemporary society, and has lectured numerous times on legal topics, and authored several articles and Special Reports on estate planning. He is a former guest columnist on Simply Money, on 91.7 FM, WVXU. He makes occasional guest appearances on radio about estate planning topics, and has been quoted in newspaper articles and columns on estate planning matters. In Mr. Zimmer’s perspective, excellence in implementing trust-based estate plans is but one aspect of his responsibility to clients. Providing reliable guidance and service to families of clients who pass away is just as critical as sound planning at the front end. The firm is very active in settling trusts of all complexity and sizes, and handling probate cases and guardianship proceedings. Zimmer and his staff have successfully handled hundreds of trust estate cases, and are experienced in settling and distributing a wide variety of estate assets to heirs. The Zimmer Law Firm 9825 Kenwood Road, Suite 201 Cincinnati, OH 45242 Phone: (513) 721-1513 Fax: (513) 287-8623 Website: www.zimmerlawfirm.com