Medicare Vs. Medicaid– What’s the Difference?

Many seniors and their family members believe Medicare will pay for an individual’s long-term care (nursing home, assisted living, and in-home care). Many people mistakenly use the words Medicare and Medicaid interchangeably thinking the two programs provide similar benefits. The programs provide different benefits.

Medicare is federal health insurance for seniors and the disabled that may provide limited benefits for skilled care. Medicaid will cover the cost of long-term care after an eligible individual pays his/her required share of the cost.

The Medicare program provides health insurance for individuals over the age of 65 as well as for individuals who are younger than age 65, but who have certain disabilities or medical conditions. Individuals may customize the Medicare coverage they receive to account for their specific needs. Additionally, with proper and timely planning, individuals can obtain Medicare supplemental policies to match their needs.

Medicare may provide an individual with limited long-term care benefits. There may be several initial hurdles which must be overcome prior to receiving the limited long-term care benefits. For example, an individual must stay in a hospital for at least three days prior to either being released directly to a skilled-nursing facility, or enter a skilled-nursing facility within thirty days after the individual’s release from the hospital. In either case, Medicare will only provide coverage if the care received in the skilled-nursing facility is for the same illness that resulted in the individual’s initial three-day hospital stay.

One an individual satisfies Medicare’s initial requirement, Medicare will pay for 100% of the individual’s stay in a skilled-nursing facility for the first 20 days. If an individual remains in need of skilled care, the individual may stay in the skilled-nursing facility for up to an additional 80 days, but Medicare requires the individual to pay a portion of the cost. If at any point during the stay the individual no longer requires skilled care, Medicare will no longer provide long-term care benefits.

In summary, Medicare provides limited coverage to individuals in need of long-term care for the purpose of rehabilitation.

Medicaid is a federal program that is administered by each state. Medicaid provides medical coverage for individuals in financial need. Each state administers its own Medicaid program so it is important to obtain information from attorneys who are knowledgeable about the program in your particular state. The Racine Olson Medicaid Planning attorneys have the experience and knowledge to help you navigate the Idaho Medicaid program.

Idaho Medicaid will pay for the majority of the long-term care costs of eligible elderly, blind, or disabled individuals. Eligible individuals who reside in a nursing home or assisted living facility must reside in a Medicaid-approved facility to receive Medicaid’s long-term care benefits. Additionally, Idaho Medicaid may pay for a portion of an individual’s care received through a Medicaid-approved in-home care provider.

In general, Idaho Medicaid eligibility is determined by looking at an individual’s (or married couple’s) assets and income. Many individuals and married couples fear the thought of losing their life savings to a nursing home or assisted living facility. The Racine Olson Medicaid Planning attorneys can help you understand the Idaho Medicaid eligibility requirements. We can also help you prepare a plan to achieve Medicaid eligibility for you or your loved one.

We are available to discuss your options and answer your questions at an initial consultation. Call us toll free at 877.232.6101 or 208.232.6101 for a consultation with the Racine Olson team of Medicaid Planning attorneys in Idaho. You can also email us directly at racine@racinelaw.net. We will answer your Idaho Medicaid questions.