Understanding government-sponsored programs can be confusing and complex. But, it is also critical to know how they affect you and your loved one’s long-term care needs.
While they are separate programs, Medicare and Medicaid both work to provide healthcare coverage. Medicare is a federal program that was designed to assist in long-term care for the elderly, persons 65 and older. It also covers people with certain disabilities.
Medicaid was created to help low-income individuals and families pay for medical and long-term custodial care. This is a federally and state funded program that has eligibility requirements that are stricter than those for Medicare coverage.
When it comes to long-term care planning, it is important to note that some people will be what’s called ‘dual eligible’ recipients; they are eligible for both Medicaid and Medicare. Essentially, as long as a financial need is proven, those recipients can get assistance that allows them to fill in the gaps not covered by Medicare.
For example, Medicaid will cover a few services not covered by Medicare. Medicare provides limited coverage for long-term care, with most benefits restricted to certain nursing facilities for a short time period. In contrast, Medicaid goes beyond these restrictions and may cover the cost of nursing homes, assisted living facilities and other long-term care options that are determined to be medically necessary.