LONGVIEW, Texas — The names are similar, and both provide certain types of health coverage, but the programs are significantly different.
Medicare is a federally funded entitlement program. This means that anyone over the age of 65 and is entitled to receives Social Security benefits is eligible for Medicare. Medicare also covers people of any age who are permanently disabled or who have end stage renal disease). Medicaid on the other hand is a public assistance program that helps pay medical costs for individuals that qualify based on certain income and asset guidelines. Medicaid is a program operated by each individual state, but if certain federal guidelines are met the state can received federal money to help offset some of the state’s costs.
A big difference between Medicare and Medicaid relates to long term care, and specifically how one can pay for nursing home care. There are several ways to pay for long term nursing home care. You can use long term care insurance, but few people have that. You can private pay, but often people do not have the money to do so or will quickly drain the lifetime savings they have worked hard for. Finally, Medicaid can be used to pay for long term nursing home care.
That said, in some situations Medicare may pay for a short period of time of nursing home care. Medicare Part A may cover up to 100 days of care in a “skilled nursing” facility if certain circumstances exist. In general, the need for skilled nursing care must follow a stay of at least three days in a hospital. The definition of skilled nursing care and the conditions that must be met are very stringent, so often time people will, at most, only receive a portion of the available one hundred days of coverage. If you do obtain coverage for skilled nursing care, Medicare will pay for the first twenty days. However, days twenty-one through one hundred are only partially paid for by Medicare.
In light of these limitations, Medicaid is the most common way to obtain assistance in paying for long term care. Since each state administers their own Medicaid programs, eligibility requirements differ from state to state, and often the programs have different names in some states. To qualify for Medicaid, you must meet certain income and asset limits. If you do qualify, Medicaid can cover a substantial amount of the long term care costs and can ultimately save individuals tens and even hundreds of thousands of dollars.
Don’t automatically think you cannot qualify for Medicaid. At Ross & Shoalmire, our attorneys and staff have years of experience in navigating the complex Medicaid rules and requirements, and we can evaluate your specific circumstances to determine if we can develop a Medicaid eligibility plan to help you qualify for Medicaid assistance. You will likely be surprised that we may be able to help you qualify.