When you’re considering placing your loved one in a nursing home or another facility to provide them with the care and assistance they need, you might worry about the cost.
Unfortunately, long-term care facilities can be expensive and cause significant financial strain. If you don’t have the financial means to pay for necessary living expenses and medical care, your relative’s health and future could suffer.
If you can’t afford to pay, you could turn to your loved one’s Medicare or Medicaid coverage. However, they are different government healthcare programs. Additionally, they might not cover certain costs associated with elder care.
Below are the main differences between Medicare and Medicaid and information about whether they can cover your loved one’s nursing home expenses, medical care, and additional costs.
Elements of Medicare
Medicare is available to U.S. citizens over 65 years old. Income is not a qualifying factor in determining who can receive Medicare coverage. If an individual worked and paid into the fund from Medicare payroll taxes, their medical expenses can be paid by Medicare.
Medicare is a four-part program with coverage for various expenses depending on the type of plan a person has. These four parts include:
- Part A – Hospitalization – Part A pays for in-patient hospital costs and services, including in-patient care and services at a skilled nursing facility.
- Part B – Medical Insurance – Part B covers outpatient services, office visits, and some forms of preventative care.
- Part C – Medicare Advantage Plans – Part C is supplemental insurance with access to additional services. Typically, it combines Parts A, B, and D into one plan.
- Part D – Part D covers prescription medications.
As it relates to long-term care, Medicare only covers 100 days in a skilled nursing facility per each spell of illness. Assistance with activities of daily living (ADLs) such as dressing, bathing, medication management, etc. is not typically covered.
Elements of Medicaid
Medicaid is an assistance program for eligible individuals of low income. The program pays for medical treatment and long-term care. Typically, covered individuals aren’t forced to pay out of pocket for their medical costs.
Various people with limited financial resources and income could qualify for Medicaid coverage. That could include:
- Children under 19 years old
- Parents or another adult caring for a child
- Adults 65 and older
- Some adults with dependent children
Federal guidelines require Medicaid to cover specific services deemed medically necessary, such as:
- Long-term care
- Services and care at a hospital or skilled nursing facility
- Doctor and nursing services
- Laboratory services and X-rays
- Home health care for individuals who qualify for nursing facility services
- Medical and surgical dental services
Additional benefits, depending on state laws, can include:
- Eyeglasses
- Medical transportation
- Prescription drugs
- Physical therapy
- Prosthetic devices
It’s important to keep in mind that Medicaid has very strict income and assets limits, and legal planning may be necessary to fall within the program’s guidelines. This must be done with the help of an experienced Tampa elder law attorney to ensure that all transfers are legal, and penalties are not incurred.
Getting Help
If you want to move your loved one into a nursing home but don’t know if they’re eligible for Medicare or Medicaid coverage, contact our Tampa elder law attorneys at (813) 438-8503. We can discuss your loved one’s needs and advise you about which benefits they may be eligible for.