Medicare Is Not Medicaid and Most Likely Will Not Pay For Long-Term Care

Medicare is our country’s health insurance program for people age 65 or older. The program helps with the cost of health care, but it does not cover the cost of most long-term care or for all a person’s medical expenses. Unfortunately, this is something that many of us do not realize for ourselves or our senior loved ones until we are facing a long-term care crisis.

Let us share a little more information on this topic to help you better understand the differences between the programs. Medicaid provides medical coverage and the cost of most long-term care for individuals who meet an eligibility test.  Medicaid nursing home services, however, are only provided for these individuals who are either age 65 or older or disabled. The federal government pays all the cost of the Medicare program. The state and federal government share the cost of the Medicaid program.  

A person over age 65 is eligible for a limited amount of Medicare skilled care coverage if he or she receives or is eligible to receive Social Security benefits. There are many restrictions that apply to Medicare coverage for skilled nursing facility care. Skilled nursing care requires that the care be provided by skilled nursing personnel or requires the supervision of skilled nursing personnel or other skilled rehabilitation persons.  As a practical matter, this care often can only be provided in a skilled nursing home facility on an inpatient basis. 

Medicare never extends coverage to a patient who needs custodial care only. For each spell of illness, Medicare Part A will pay all the costs for a covered skilled nursing home stay for the first 20 days and all but $170.50 per day in 2019 for up to an additional 80 days as long as the individual was a patient in a hospital for three consecutive days, not including the day of discharge. In addition:

  • The patient must be admitted to the skilled nursing facility within 30 days of discharge from the hospital; 
  • A doctor must certify that the patient needs skilled nursing home care; 
  • The services are provided by or under the supervision of a trained individual; 
  • The services are received on a daily basis, which means therapy services at least 5 days per week and/or nursing care seven days per week;
  • The services are provided by a Medicare-certified skilled nursing facility and the skilled services must be provided on an inpatient basis.

We know how challenging it is to understand the differences between Medicare and Medicaid. Do not wait to schedule a first meeting with attorney Donna Wilson to have your questions answered. We look forward to helping you and your loved ones plan forward for your long-term care needs.