Florida Medicare & Medicaid Laws

Medicare is a federal health care insurance program for seniors and the disabled. Medicaid is a joint federal and state financial health care assistance program. There can be significant differences in Medicaid programs between Florida and other states. Applications for Medicare are made through local Social Security offices and eligibility is based upon age, contribution and disability, not income. Applications for Medicaid are made at the state Medicaid office and eligibility is based on income and disability. Both programs can be quite complicated, so it is important to get professional advice from a Medicare/Medicaid adviser or lawyer.

Medicare and Medicaid Comparison

• Medicare is similar to private health care insurance in that a person receiving Medicare has a choice of plans and options, deductibles apply and, in many cases, a monthly premium payment is required. Also, like private insurance, there is a complex maze of what is covered and what isn't. Medicaid is financial health care assistance for those in financial need. It requires no premium payments or deductibles, and it is possible to have both Medicare and Medicaid.

Medicare Eligibility

• Everyone over 65 is eligible for Medicare

  Medicare is a national health care insurance program for people over 65, some disabled people under 65 and people of any age who have end-stage renal disease (those receiving a kidney transplant or on dialysis for permanent kidney failure). To qualify for Medicare coverage with no monthly premium (Plan A only), a person (or his spouse) must have been employed in Medicare-covered employment for 10 years and be a United States citizen or permanent resident. A person does not have to stop working in order to receive benefits.

Medicaid Income Eligibility in Florida

• Income eligibility limits for Medicaid in Florida are based upon the Federal Poverty Level. When determining the monthly income of the applicant, certain deductions are allowed, such as uncovered medical costs and medical insurance premiums.

Medicaid Income Caps

• Spousal income is not factored in when determining Medicaid eligibility.

  Florida is an "income cap state," which means that Medicaid assistance will not be available if the applicant's monthly income is above a certain amount (adjusted periodically; $2,022 in Florida for 2010). Spousal income is not considered. Under certain conditions, income in excess of the cap can be put in a "(d)(4)(B)," or "Miller" trust to allow the applicant to qualify.

Medicaid Asset Limits

• Unlike income, if a Medicaid applicant is married, the applicant's and her spouse's assets are considered together. For a nursing home resident to be eligible for Medicaid, the applicant (and spouse) must have less than $2,000 in "countable assets." In Florida, countable assets do not include the applicant's home, unless the home has equity of $500,000 or more (however there are some exceptions). Personal possessions are also excluded, along with one car (regardless of value), one additional car (if needed for health or self-support reasons), pre-paid funeral plans, some life insurance and assets that are considered "inaccessible" for one reason or another.