Medicare and Medicaid are two programs that may be confusing to navigate after the loss of a loved one. The following is information regarding the differences between the programs, who is eligible for them, and how they might be useful in end-of-life matters.
The difference between Medicare and Medicaid
Medicaid-Medicaid is an assistance program that serves low-income people of every age. Patients usually pay no part of the costs covered for medical expenses, but a small co-payment is sometimes required. Medicaid is a federal-state program, but it varies from state to state.
Medicare-Medicare is an insurance program that pays medical bills from trust funds that those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients.
In sum: Medicaid is an assistance program based on income and Medicare is an insurance program based on age and disability.
Medicaid
Eligibility
- In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states, and if you are unsure if you qualify for coverage, the recommendation is to apply regardless here.
- Medicaid is based on income, which makes the qualifying income for married couples different than for singles. If someone’s spouse passes away, their income may now qualify them for Medicaid.
How to Apply
There are two ways you can apply for Medicaid:
- Directly with your state.
- Through the Health Insurance Marketplace®.
- Visit HealthCare.gov to create a Marketplace account and complete an application.
- Reply “yes” when asked if you’d like to see if you can get help paying for coverage.
- If the information on your application shows that someone in your household might qualify for Medicaid, the Marketplace will forward your application to your state for a final eligibility decision.
- You can also call the Marketplace Call Center at 1-800-318-2596 to apply. TTY users can call 1-855-889-4325.
Use in end-of-life matters
- Medicaid does not directly cover funeral expenses or the cost of a cremation or burial.
- Medicaid does enable recipients to earmark funds for their own funeral and burial, while the funds will not be included with other assets recorded when determining eligibility for benefits. Therefore, the only benefits able to be gained from Medicaid must be pre-planned. More information here.
- Some states will use Medicaid enrollment to determine eligibility for state-based funeral support. To determine if your state does this, search your state’s name + Medicaid funeral expense.
Medicare
Eligibility
- For most people, Medicare eligibility, called the initial enrollment period, starts three months before turning 65 and ends three months after turning 65. Some people get Medicare automatically. For cases outside of the 6 months around your 65th birthday, see here.
How to Apply
Use in end-of-life matters
- In general, Medicare itself does not pay for any funeral or burial expenses.
- The only means for saving money in a Medicare account for funeral expenses are Medicare medical savings account or a Medicare MSA, which will transfer to a beneficiary upon death. More information here.