Aging is expensive. Physical changes increase the risk of illness, and physical and cognitive changes heighten the risk of injuries as people age. Consequently, although adults 65 and older only accounted for 17% of the U.S. population in 2020, they accounted for 37% of all personal healthcare costs. The average per-person personal healthcare costs for seniors was over $22,000 in 2020, more than double that for working-age adult females ($9,989) and working-age adult males ($8,313).
Although many older Americans already face financial challenges that prevent them from retiring, some are unable to continue working or living independently because of severe health issues. Fortunately, government programs, such as Medicaid and Medicare, can cover some seniors’ expenses. Understanding the difference between Arizona Medicare and Medicaid, what they cover, and how to qualify can help you get the assistance you need for your personal and medical care.
What Is the Difference Between Medicaid and Medicare in Arizona?
Medicaid and Medicare are government-funded assistance programs for U.S. citizens and permanent residents. These programs share some similarities. For example, both Medicaid and Medicare offer multiple plans users can choose from, allowing individuals to customize their plans based on their needs. Medicare users pay monthly premiums and deductibles, and states have the option of charging Medicaid users monthly premiums, deductibles, and copays.
However, there are critical differences in how these programs are funded, who typically qualifies for benefits, and what they fund.
Funding Source
Arizona and the federal government share the costs of Arizona Medicaid funding for seniors. The federal government covers the costs of Arizona Medicare for seniors.
Primary Clients
Medicaid primarily assists families and individuals with low incomes. Income isn’t a factor when determining who qualifies for Medicare. Medicare primarily provides benefits for seniors; however, it also provides benefits for individuals with disabilities.
What Medicaid and Medicare Cover
Medicare focuses on limited medical coverage and covers things like the cost of a doctor’s appointment, but it does not cover all expenses. Examples of costs Medicare doesn’t cover include the following:
- Assisted living facility costs
- Cosmetic surgery
- Dental appointments
- Eyeglasses
- Hearing aids
- Massage therapy
Some approved costs depend on the reason for care. While the costs of foot care are typically not covered by Medicare, they are covered if a person needs to see a podiatrist because of diabetes-related foot issues.
Medicare does not cover senior care facility costs unless an individual requires care in an assisted living facility due to Alzheimer’s or dementia or a doctor refers them for short-term care of 100 days or less because of medical issues. However, Medicare Part A does cover the costs of skilled nursing facilities.
Medicaid Long-Term Care Options: Does Medicaid in Arizona Cover Assisted Living or Nursing Home Care?
The types of long-term care facilities available for seniors include assisted living, nursing homes, and skilled nursing facilities. While assisted living facilities may allow individuals to retain more independence, senior care facilities, such as nursing homes, provide more direct care and around-the-clock supervision.
Arizona’s average monthly cost of assisted living care is $4,000, equal to $48,000 annually. Medicaid covers assisted living and nursing home facility costs for some seniors. Since Medicaid benefits are based on income, seniors must meet the income requirements to qualify.
What Other Medical Expenses Does Medicaid Cover for Seniors in Arizona?
Medicaid covers dental costs for those 21 and under. Most individuals on Medicaid can use it to cover eye exams and the cost of eyeglasses. Medicaid also covers hearing tests and hearing aid costs.
Like Medicare, Medicaid does not cover massage therapy.
Can I Qualify for Both Medicaid and Medicare in Arizona?
All seniors qualify for Medicare. Seniors with medical needs may qualify for Medicaid if they meet the income requirements. Arizona Seniors eligible for Medicaid can maximize their healthcare coverage with both programs.
Who Qualifies for Medicaid as a Senior in Arizona?
Seniors who exceed the income limits do not qualify for Medicaid in Arizona. The income limits vary depending on whether an individual or a married couple applies. Income limits depend on the type of coverage sought. For example, an individual seeking regular Medicaid benefits can qualify if their income is $1,255 per month or less, with no limits on their countable assets. However, an individual seeking Medicaid coverage for assisted living facility costs can earn no more than $2,829 monthly and must have countable assets of $2,000 or less.
What Medicare Plans Are Available for Seniors in Arizona?
Medicare offers Plans A, B, C, and D. Individuals choose their plans. Plan A pays for hospitalizations and long-term care in assisted living or nursing home facilities. Plan B is for outpatient services, such as doctor appointments. When people reference “original Medicare,” they refer to Parts A and B coverage.
Seniors can opt for Part C, which combines Parts A and B. Known as Medicare Advantage, seniors opting for Part C must secure this coverage through private insurance companies.
Those with Medicare Part D can use it to cover the costs of prescription medications.
Individuals can also pay for Medigap (Medicare Supplemental Insurance). Depending on your Medigap plan, you may have coverage for services not provided through Medicare and a cap on out-of-pocket costs.
How Does Arizona Medicaid Assist With Prescription Drug Coverage?
Medicaid covers the costs of prescription medications. Seniors who qualify for Medicaid can rely on it to pay for their prescriptions.
How Do I Apply for Medicaid in Arizona as a Senior?
You can use an online form to begin the Medicaid application process. You can also phone Arizona’s Regional Behavioral Health Authority (RBHA) offices for questions or assistance.
Meeting Your Medical Needs at Haven Health
Seniors needing short-term care in a skilled nursing facility may be able to use Medicare to cover those costs. Seniors needing long-term care in a nursing facility may be able to use Medicaid to cover those expenses if they qualify for Medicaid benefits. Haven Health offers short and long-term medical and personal care programs. We can explain your program and financing options to ensure you get the necessary coverage and care.
Sources:
Apply for AHCCCS Medical Assistance/KidsCare. (2024).
Arizona Medicaid Income & Asset Limits for Nursing Homes & In-Home Long Term Care. (2024).
Avoiding Injuries as You Age. (2024).
Ghilarducci, T., et al. (2023). No way out: Older workers are increasingly trapped in crummy jobs and unable to retire.
How to Apply for Medical Assistance. (2024).
U.S. Personal Health Care Spending By Age and Sex: 2020 Highlights. (2024).