What’s The Difference Between Medicare and Medicaid?
Medicare and Medicaid sound alike, and many people use them interchangeably. However, they are very different programs. Medicare is a federal program that provides health coverage to insured workers who are age 65 or older or who have a disability. Medicaid is a state and federal program that provides health coverage to persons with low income and, for some Medicaid programs, limited assets. Also, unlike Medicare, which is totally federal, Medicaid is a joint state-federal program. Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive federal money, which pays for about half the state’s Medicaid costs.
Medicare and Medicaid Coverage of Long-Term Care
One of the major differences between Medicare and Medicaid is in the context of coverage of long-term care services. Medicaid covers nursing home care for qualiﬁed persons. Medicare, however, for the most part, does not cover nursing home care. Medicare Part A covers only up to 100 days of skilled care in a “skilled nursing” facility per spell of illness. The care in the skilled nursing facility must follow a stay of at least three “midnights” in a hospital. And for days 21 through 100, you must pay a copayment of $194.50 in 2022 ($185.50 in 2021). (This may be covered by Medicare supplemental insurance.)
Because of the lack of Medicare coverage and the high cost of nursing home care, Medicaid has become the default nursing home insurance program. Most people pay out of their savings for long-term care until they become eligible for Medicaid.
Medicare does not cover assisted living or custodial home care (assistance with feeding, dressing, toileting, bathing and moving around). It will provide limited skilled services in the home.
In Illinois, Medicaid does pay for some home care (usually not more than 20 hours a week) through the Illinois Community Care program administered by the Department on Aging.
It also covers assisted living through its Supportive Living certiﬁed facilities. Medicaid will not cover live-in caregivers.
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This information is not to be considered legal advice. If you have questions about the differences between Medicare and Medicaid in relation to long term care, please contact us.