• Laura Cassell

Understanding Medicare and Medicaid | How are they different?

I want to start off this blog by answering common questions I've received regarding Medicare/Medicaid in Florida. Hopefully throughout this blog, I'll answer some questions and provide support through understanding each. (My answers will be tailored to policies in Florida).


It's extremely common for people to misunderstand the difference between Medicaid and Medicare. Although Medicaid and Medicare programs help senior, low-income and disabled citizens cover many health-related expenses, they are very different programs in Florida.

1. What is the difference between Medicare and Medicaid?

Medicare is a type of health insurance for seniors, disabled individuals, or anyone with permanent kidney failure. Medicare is funded by Social Security tax contributions (FICA). Unlike Medicaid, Medicare is an entitlement program that most senior citizens enroll in at age 65.


Florida Medicaid is a needs-based program with benefits determined by the individual’s financial and medical position.


2. Who is eligible for Medicaid in Florida?

Medicaid is a wide-ranging, federal, health care program for low-income individuals of any age. If you meet a nursing home level of care (and are 18 or over), you can qualify for Florida’s managed long-term care program only if you meet the income and resource limits. If you are wondering if you are eligible to received Florida Medicaid benefits, you must be one of the following:

  • Pregnant

  • Be responsible for a child who is 18 years of age or younger

  • Blind

  • Have a disability or someone in your household has a reported disability

  • 65 years or older

To be eligible for Medicaid in Florida, you HAVE to be a Florida resident and a United States citizen (with documentation to prove it). Also, documentation is required showing the person is in need of health care or insurance assistance.

3. How does Eligibility work for Florida residents who are 65 years or older?


According to the American Council on Aging (2020), Medicaid for Florida residents who are 65 years or older is contingent on the amount of income and asset/resources a person has; and to further complicate the eligibility, marital status can alter the ability to be qualify for the Florida Medicaid benefits.


According to 2020 MH Sub I, LLC, if you receive SSI, you are eligible. Otherwise, your monthly income must be NO MORE than $2,313, or $4,626 (in 2019) for spouses who are both trying to qualify for Medicaid long-term care benefits. The resource (asset) limit for a "single" person to qualify for Medicaid in Florida in 2019 is $2,000, and it is $3,000 for a married couple when both spouses want to qualify. Medicaid in Florida is also referred as the Statewide Medicaid Managed Care (SMMC) program (Nolo, 2020).


What Defines "Income?"

For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends (American Council on Aging (2020).


What Defines "Assets?"

Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant either resides in the home or has “intent” to return to it (American Council on Aging (2020).


4. Are Medicare/Medicaid programs different state-to-state?

  • Medicare, is a federal program.

  • Medicaid is administered by each state. As a result, eligibility requirements differ from state to state, and different states may cover different procedures and treatments than others.

If you need further help with understanding if you or your loved will be eligible for medicaid benefits in Florida, schedule an Eldercare Consulting meeting through the Contact page. Through this appointment, we'll discuss the various benefit options that could help you pay for aging care services and/or to help you enroll into medicaid benefits and veteran benefits as a Florida resident.

Laura Cassell, CDP & Gerontologist in Florida

Email: laurac@seniorcareauthority.com


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