Medicare Basics for Texans 65+
Disclaimer: This blog post is not legal advice and is for educational purposes only. This blog post does not create an attorney-client relationship. If you would like to speak to an attorney about a legal matter, please reach out to us today!
Understanding Medicare
Medicare provides critical healthcare coverage for those aged 65 and older or individuals with specific conditions, including certain disabilities and End-Stage Renal Disease (ESRD). Medicare consists of four parts:
• Part A covers hospital services.
• Part B covers medical services.
• Part C offers Medicare Advantage plans.
• Part D provides prescription drug coverage.
Medicare Part A is premium-free for those who paid Medicare taxes through employment. Part B, however, requires a monthly premium, with 2024’s rate projected at $257.
Breakdown of Medicare Coverage
• Part A (Hospital Insurance): Covers inpatient care, skilled nursing, and some home health services.
• Part B (Medical Insurance): Covers outpatient care, preventive services, and medical supplies.
• Part C (Medicare Advantage): An alternative to traditional Medicare with all-in-one coverage.
• Part D (Prescription Drug Coverage): Optional and requires an additional premium for drug cost coverage.
Example Scenario
Consider a 67-year-old Texan named Marie. Marie’s spouse paid Medicare taxes throughout their working years, so Marie qualifies for premium-free Part A. She opts for Part B to cover outpatient care. Marie can also add Part D for prescription coverage or join a Medicare Advantage plan, which includes prescription benefits.
Medicare vs. Medicaid for Long-Term Care
While Medicare provides essential medical coverage, it does not pay for most long-term care services like nursing home care. Texans who need such care and meet eligibility should consider Medicaid for long-term support. Medicare does offer some short-term coverage after hospital stays, but Medicaid remains the primary source for extended care.
Using Trusts to Protect Assets
Individuals in Texas can protect assets while preparing for Medicaid or Medicare by using a Special Needs Trust (SNT). For those without significant heirs, a first-party SNT can safeguard assets and meet Medicaid’s stringent limits. Managed by a trustee, an SNT can cover supplemental needs without disqualifying the individual from Medicaid or Medicare benefits.
Summary
Medicare provides substantial healthcare coverage for older adults, but understanding its limitations, particularly for long-term care, is crucial. Texans needing nursing home care or extended services should plan to integrate Medicaid or alternative options alongside Medicare to fully address healthcare needs.
