What is the Difference Between Medicare and Medicaid?
Medicare and Medicaid sound alike, and many people use them interchangeably. However, they are quite 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. Each state runs its own Medicaid system, but this system must conform to federal guidelines 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 (about 3 and a half months) 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. For days 21 through 100, you must pay a copayment of $194.50 in 2022. This may be covered by Medicare supplemental insurance.
Because of the lack of Medicare coverage and the inflated 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 (aid with feeding, dressing, toileting, bathing, and moving around). It will supply limited skilled services in the home, though. 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, though it does not pay for live-in caregivers. Medicaid also covers assisted living through its Supportive Living certified facilities (see Additional Resources).
Medicaid requires an application to be enrolled, while Medicare does not. Medicaid applications are extremely lengthy and often require appeals. There is a 5-year look-back period in which Medicaid requires financial statements going back 5 years. In addition to financial records, there are other documents that need to be gathered for the application. To learn more about what’s needed for a Medicaid application and how we can help you, visit the Medicaid page on our website: https://duttonelderlaw.com/elder-law-medicaid/.
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- Community Care Program — https://ilaging.illinois.gov/programs/ccp.html
- Supportive Living Facilities — https://www2.illinois.gov/hfs/MedicalPrograms/slf/Pages/locate.aspx
- Medicare – www.medicare.gov
- National Elder Law Foundation — www.nelf.org
- National Academy of Elder Law Attorneys — www.naela.org
This information is not to be considered legal advice.