Legal Matters

Medicare vs. Medicaid for Long-Term Care What will they Pay?

They sound alike, but they aren’t. Medicaid and Medicare are quite different programs. Everyone 65 and over (some younger) that receive Social Security benefits also receive Medicare.

On the other hand, Medicaid is a program that helps pay for long-term care for individuals with limited income and assets. To be eligible for Medicaid, you must meet the program’s income and asset guidelines.

Also, unlike Medicare, which is federal, Medicaid is a joint state-federal program. Each state operates its own Medicaid system, but it must conform to federal guidelines.

The most significant difference between Medicare and Medicaid is that Medicaid covers the cost of a nursing home (and some home care or assisted living), while Medicare, for the most part, does not. Medicare fully covers 20 days of rehabilitative care in a “skilled nursing” facility that follows a stay of three or more days in a hospital. But for days 21 through 100, you will have a

co-payment of $167.50 unless you have a supplemental policy. And if you stop making “progress,” Medicare will stop paying.

When it comes to long-term care, Medicaid has become the long-term care insurance of the middle class. Lacking access to alternatives such as paying privately or being covered by a long-term care insurance policy, most people pay out of their own pockets for long-term care until they become eligible for Medicaid. But that could have been avoided had they done some planning.

The best results happen when someone plans at least five years before needing Medicaid. But even those that plan at the last-minute benefit significantly.

Scott Selis, Elder Law Attorney, estate planning, probate, long-term care, government benefits, (Medicaid, Veteran’s benefits). Scott was Assistant Chair of Florida Bar’s Elder Law section, and Elder Law Attorney of the Year 2016.