Differences Between Medicare and Medicaid in Virginia

When you’re considering healthcare options or in-home care in Virginia, it’s important to understand the difference between Medicare and Medicaid. These two programs serve different purposes but often work together to ensure seniors, people with disabilities, and those in need can access care.

In Virginia, over 1.6 million residents are enrolled in Medicaid, showing how important this program is for families across the state.

This article covers the differences between Medicaid and Medicare. We’ll also guide you on how Nurse Next Door McLean, a trusted home health service in Virginia, can help you meet your care goals through Medicaid.

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What is Medicaid?

Medicaid is a state-administered health coverage program funded by both the federal government and the Commonwealth of Virginia, managed by the Virginia Department of Medical Assistance Services. It provides comprehensive health coverage to eligible low-income Virginians, including seniors and people with disabilities.

What Does Virginia Medicaid Cover?

• Doctor visits and hospital care
• Prescription medications
• Preventive services
• Long-term services and support, including home and community-based services and nursing care facilities.
• Personal care assistance at home for eligible seniors
• Behavioral health services
• Transportation to medical appointments

Virginia offers specialized Medicaid programs for seniors, including:

• CCC Plus (Commonwealth Coordinated Care Plus): Managed care for individuals with complex needs, providing in-home care and long-term support
• PACE (Program of All-Inclusive Care for the Elderly) may help seniors who are eligible for nursing facility care but who wish to remain at home

What is Medicare?

Medicare is a federal health insurance program managed by the Centers for Medicare & Medicaid Services. It serves:

• Seniors aged 65 and older
• Some younger people with disabilities
• Individuals with End-Stage Renal Disease or ALS – “Lou Gehrig’s Disease”

What Does Medicare Cover?

Medicare is divided into parts:

• • Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing care at a residential facility, end-of-life hospice care, and some home healthcare services.
  • Part B (Medical Insurance): Covers outpatient care, doctor appointments, preventive services, and medical equipment such as wheelchairs, hospital beds, and oxygen equipment for use at home. However, this coverage depends on certain criteria and approvals. 
  • Part C (Optional Medicare Advantage): Provides all of Parts A and B through private third-party insurers, thereby also offering extra coverage, such as dental, hearing, vision, and health and wellness.
  • Part D (Prescription Drug Coverage): Covers generic and brand-name prescription medications.

Most people don’t pay a premium for Medicare Part A if they or their spouse has worked for at least 10 years. Most Virginians pay the standard Medicare Part B premium.

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Who Manages Medicare and Medicaid in Virginia?

Medicare is fully managed by the federal government, ensuring consistent rules across the U.S., including Virginia. Medicaid, on the other hand, is administered at the state level by DMAS. This allows Virginia to define its own eligibility guidelines, covered services, and application processes within federal regulations.

This crucial difference in management affects how services are accessed and what additional supports are available to seniors and families in Virginia.

Differences in Eligibility: Medicare vs Medicaid in Virginia

Medicare Eligibility in Virginia:

Medicare eligibility is based on age or qualifying disabilities, not income. NOTE: The recipient must be a U.S citizen or permanent resident.

To qualify for Medicare in Virginia, the applicant must meet at least one of these conditions:

• Age 65 or older
• 24 consecutive months of receiving Social Security Disability Insurance (SSDI)
• End-Stage Renal Disease
• ALS/Lou Gehrig’s Disease

Medicaid Eligibility in Virginia:

Medicaid eligibility depends on multiple factors, like how old you are, how much you earn, if you have any disabilities, your tax-filing status, the size of your household, etc. 

To find out whether you are eligible or not, click here or reach out to Nurse Next Door McLean for guidance. 

Some Virginians qualify for both Medicare and Medicaid (“dual eligibility”), allowing Medicaid to help cover services Medicare does not, such as long-term care at home.

Medicare vs Medicaid in Terms of Coverage

Medicare is designed to cover hospital care, outpatient services, preventive care, and short-term skilled nursing or rehabilitation after a hospital stay. It does not cover long-term personal care, such as ongoing assistance with bathing, dressing, or daily living tasks over extended periods.

Virginia Medicaid provides comprehensive medical care like doctor visits, hospital care, and prescriptions while also covering long-term services and supports (LTSS), including home and community-based services and nursing facility care for eligible seniors. Medicaid is often essential for seniors requiring ongoing personal care to remain safely at home.

Because Medicaid includes coverage for LTSS that Medicare does not, many families in Virginia rely on Medicaid to supplement Medicare for comprehensive, long-term support for their goal of aging in place.

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How Nurse Next Door Supports You

At Nurse Next Door McLean, we help seniors and families explore Medicare vs Medicaid while planning compassionate in-home care. Our tailored Medicaid support includes: 

• Eligibility Guidance: We help you check Medicaid eligibility and guide you through the application and approval process. 
• Trained and Experienced Caregivers, including Certified Nursing Assistants, Home Health Aides, and Personal Care Assistants.
• Long-Term Care: Through the Medicaid program, we bring long-term care to your doorstep with compassionate and reliable caregivers. We match you with the most suitable caregiver who can meet your unique needs and help you make the most of your golden years. 
• Activities of Daily Living (ADLs): We offer personalized care to help with various daily activities like bathing and meal preparation. We also provide in-home dementia care and respite care.

After understanding Medicare vs Medicaid in Virginia, you should look for the right caregiver for your loved one to improve their quality of life through these programs. Many seniors benefit from dual eligibility, using both programs together to ensure comprehensive, affordable care.

At Nurse Next Door Virginia, we are committed to helping you and your family navigate these programs confidently while delivering the compassionate, personalized care you need and deserve.

Ready to learn how Medicare and Medicaid can help your family in Virginia? Contact Nurse Next Door McLean today.