Medicare

The Difference Between Medicare and Medicaid

Published on: August 31, 2022 | By David W. Miller

Medicare and Medicaid have similar names but are two completely separate government health insurance programs. Understanding the difference can help you and your family plan for aging and retirement.

What is Medicare?

Medicare is a program administered by the federal government—the Centers for Medicare & Medicaid services—that is essentially available to anyone, regardless of income. If you are over 65 years of age or are younger and have a specific disability, you may qualify for Medicare. People covered under Medicare pay into a trust from which medical bills are paid. Most long-term care costs are not covered under Medicare, making it difficult for aging individuals and their families to pay for care facilities or long-term rehabilitation.

What is Medicaid?

Unlike Medicare, Medicaid is administered by individual states, such as Texas. It is catered to serve low-income people at any age, and also covers the costs of long-term care in nursing home facilities. In Texas, Medicaid is extremely complex and can be difficult to navigate. Medicaid applicants must either have a disability, be caring for a disabled child, or have a monthly income under a limit set by the government each year. Medicaid applicants must also have less than $2,000 in certain assets, which can exclude primary residences, vehicles, and some personal property. The government will look at the most recent five years of financial statements to ensure an applicant’s eligibility, making it difficult for applicants to transfer assets in anticipation of filing for Medicaid benefits if they wait until the last minute.

Texas Medicaid Estate Recovery Program (“MERP”)

Published on: July 1, 2022 | By David W. Miller

Medicaid is a state and federal program that provides medical coverage and payment to eligible persons. The Texas Medicaid program strives to improve the health of Texas who might otherwise go without medical care and treatment. To qualify for Texas Medicaid, the individual must be a Texas resident, a U.S. national, citizen, permanent resident, or legal alien who needs insurance assistance/health care and whose financial situation is characterized as low income. Further, the person must also be:

Pregnant, or
Be responsible for someone 18 years old or younger, or

Will Medicare Cover The Cost of a COVID Vaccine For Texas Residents?

Published on: October 30, 2020 | By McCulloch & Miller, PLLC

During these unprecedented times, Houston residents have many questions about a potential COVID vaccine and whether it will be covered by Medicare. Medicare is a national health insurance program that provides insurance for Americans 65 or older and some younger individuals with a disability. Similarly, Medicare Advantage is a type of health insurance plan that provides Medicare benefits through a private-sector health insurer, rather than the government. In Texas, over 4 million people rely on Medicare for their health needs. Because of this, it is important to know whether individuals with Medicare will have to pay out of pocket for a COVID vaccine – something many cannot afford – or whether it will be covered by Medicare. Those with questions about what Medicare covers can reach out to a Houston estate planning attorney for assistance.

Good and Bad News About The CARES Act

The CARES Act provides that if a COVID-19 vaccine becomes available, Medicare is required to cover the cost under Part B. Ordinarily, Medicare Part B helps to pay for doctor visits, preventive services, and vaccines such as the flu and pneumonia shots. Additionally, Medicare Advantage plans are required to include the basic coverage offered by Medicare Parts A and B, meaning a COVID-19 vaccine would also be covered for those with Medicare Advantage plans.

Planning for Medical Expenses During Retirement

Published on: November 18, 2019 | By McCulloch & Miller, PLLC

The unknown about spending in retirement is not just whether it will be higher or lower, but when during the course of retirement, you’ll be spending more or less. If you downsize, housing costs will decrease, but if you travel more, recreational spending will rise.

According to a recent article from Investopedia, “How to Plan for Medical Expenses in Retirement,” healthcare is likely to be the biggest expense in retirement. A survey from Fidelity Investments found that a 65-year-old newly retired couple should budget about $285,000 for medical expenses in retirement. It is better to have the money set aside than to be surprised by the cost. That number also does not include long-term care. Depending on where you live, those costs can range from $18,720 for adult day care services to $100,375 for a private room in a nursing home.

Despite saving and preparing for retirement their entire lives, many retirees aren't mentally or financially prepared for these types of expenses. A survey by HSA Bank found that 67% of adults 65 and older thought that they’d need less than $100,000 for healthcare. However, Fidelity calculated that males 65 and older will need $133,000—and females, $147,000—to pay for healthcare in retirement.

Medicare Doesn’t Cover Everything

Published on: July 8, 2019 | By McCulloch & Miller, PLLC

Life before Medicare was a real struggle for seniors without healthcare coverage. Today’s program still works wonders, but it doesn’t cover everything.

Once you turn 65, you are eligible to take part in the Medicare system of healthcare. It can be a little confusing to apply, and sometimes a little hard to figure out what it will and won’t cover. Traditional Medicare, also known as “Original Medicare,” should cover most of your medical expenses through Medicare Part A and Part B. Part A is all about hospital insurance: inpatient stays, skilled nursing facilities for some costs, surgery, hospice care and some home health care. Part B helps to pay for things like some medical equipment and supplies, some preventive services, doctor visits and outpatient care. Three months before you reach age 65, you need to sign up for Medicare.

Kiplinger’s article, “7 Things Medicare Doesn't Cover,” takes a closer look at what isn't covered by Medicare, plus some information about supplemental insurance policies and strategies that can help cover the additional costs, so you don't end up with unanticipated medical bills in retirement.

Medicare Facts and Penalties You Need to Know

Published on: August 24, 2018 | By McCulloch & Miller, PLLC

Start with the basics, to make sure you’re making informed decisions.

Created in July 1965 as part of the Social Security Act, Medicare is how most adults over age 65 cover their healthcare costs. Medicare has four parts. They are Part A: Hospital, Part B: Outpatient Services, Part C: Medicare Replacement and Part D: Prescription Drugs. This useful article from Think Advisor, “Essential Medicare Facts & Penalties Advisors Should Know on One Page,” covers Medicare fundamentals.

As a general rule, if you are 65 and you or your spouse have paid Medicare taxes for at least 10 years, you may enroll in the program. Those under 65 may also enroll, if they are disabled or have end stage renal disease.

What Free Services Does Medicare Provide?

Published on: April 11, 2018 | By McCulloch & Miller, PLLC

Ben Franklin said, “An ounce of prevention is worth a pound of cure.” That’s why Medicare provides free screenings and examinations focused on prevention.

Yes, you still have to spend a lot of out-of-pocket money on healthcare, but a recent article in AARP ,“10 Free Services Medicare Provides,” reports that the Affordable Care Act (ACA) expanded access to free preventive care, including a number of screenings and examinations. These are all helpful to maintaining good health.

A “Welcome to Medicare” Preventive Visit. Available only in the first 12 months you’re on Part B, this visit includes a review of your medical history, some screenings and shots, measurements of vital signs, a vision test, a review of potential risk for depression, the opportunity to discuss advance directives, as well as a written plan detailing the screenings, shots, and other preventive services you should have. This visit is covered only once, but it’s a good perk.

Why You Need Long-Term Care Insurance

Published on: December 14, 2017 | By McCulloch & Miller, PLLC

The cost of long-term care insurance may not be cheap, but the cost of long-term care is extremely expensive, and is only moving higher.

Long-term care insurance is costly, but health care costs for seniors who need long-term care could easily undo decades of retirement planning. Here’s what you need to know about the costs and benefits of long-term care insurance.

The Chicago Tribune’s recent article, “Thinking of buying long-term care insurance? Consider these costs,” reports that a 2015 cost of care survey from insurance company Genworth Financial estimated the national median cost of care for a home health aide to be almost $46,000 annually, while the national median cost for a private nursing room home is more than $91,000 annually.

The Big Mistake People Make About Medicare and Assisted Living

Published on: October 16, 2017 | By McCulloch & Miller, PLLC

A large percentage of Americans require assisted living care at some point during their senior years. Their understanding of how that gets paid for is way off base. It’s a hard lesson to learn.

Approximately one-third of Americans (34%) thought that Medicare would cover their nursing home costs, as reported in a survey from the Associated Press-NORC Center for Public Affairs Research. Another third, 27%, may have been a little smarter to say that they weren’t sure.

That’s not true, says WRAL’s recent post, “Expect Medicare to cover assisted living? Think again.” These results may correlate with the fact that only 37% of Americans think they’ll need any care in their later years, but in reality, about 70% will require this care.

More Changes Coming to Medicare in 2018

Published on: August 10, 2017 | By McCulloch & Miller, PLLC

Higher fees are coming to high earners, when income thresholds for the highest surcharge tiers drop even further next year.

If you were hit with premium surcharges for Medicare Part B and Part D already, these costs will increase again in 2018, according to a recent article in Kiplinger, “Medicare Surcharge Thresholds to Drop.”

This recalibration of the trigger points was a part of the Medicare Access and CHIP Reauthorization Act of 2015, also called the "Doc Fix" law, which ended the annual battles over fee schedules for doctors' Medicare payments. To help pay for the permanent fix, lawmakers have asked high-income beneficiaries to foot the bill.