Medicare or Medicaid: Senior Care & Nursing Home Costs

  • What does Medicare cover?

    Medicare is divided into four different parts. Part A covers in-patient and hospice care. Part B covers outpatient services. Part C grants plans that lower the government costs while still allowing patients to choose the benefits that meet their needs.

    Part D covers prescription drugs. Medicare can also cover rehab stays in nursing homes for short periods after injuries or surgeries. Rehab and therapy at home may also be covered for a restricted period of time if ordered by a doctor.

  • What doesn't Medicare cover?

    Medicare doesn’t cover assisted living, long-term care at a nursing facility, residential care homes, or any long-term care.

  • What is Medicaid?

    While Medicare is a Federal program, Medicaid programs can vary depending on the state. Medicaid pays benefits directly to the provider and is the primary source of health insurance for low-income people.

    Medicaid can cover long-term care in nursing homes and is the primary way nursing home residents pay for their stays. Only those who are low-income or how have already exhausted their own savings and retirement money can qualify for Medicaid programs.

Medicare is a single payer health insurance program that is nationally based. American’s 65 years of age must sign up for Medicare.  It will be their first source of health insurance.  Cost not covered by Medicare, approximately 50%, need to be covered by private insurance, supplemental insurance or out of pocket.

Medicare is health insurance for American’s 65 or older.  Working American’s have paid into Medicare through their payroll tax.  Medicare also provides health insurance for those younger than 65 who are disabled as determined by the Social Service Administration.

Medicare has grown substantially as a program since its inception in 1966.

Medicare Part A, B, C, D

  • Medicare Part A covers in patient and Hospice care.
  • Part B covers outpatient services.
  • Part C is an option meant to grant plans or parts of plans that will lower the cost to the government which while continuing to allow patients to choose plans where the benefits meet their needs. (Medicare Advantage Plans)
  • Part D covers prescription drugs

Medicare will pay for short periods of rehab stays in a nursing after surgeries or injuries.  I can also pay for rehab/therapy at home for a restricted period of time if ordered by a doctor.

 Medicare will Not cover:

  • Assisted living
  • Long term care at a nursing home
  • Residential care homes
  • Any long-term care

Medicaid

Unlike Medicare which is a Federal program, Medicaid is funded mutually by the federal government and state governments.  States establish and administer their own Medicaid programs working within broad federal guidelines.  States will develop programs that determine services, duration of services and the type of services.

In some states Medicaid recipients, will be required to pay a co-fee for services.  Medicaid pays benefits directly to the provider.

Medicaid is the primary source of health insurance for low-income people.

Most of our Elderly will have to exhaust their own savings, retirement and other personal money before they will qualify for Medicaid support unless they are already part of the low-income bracket.

Medicaid is an insurance program that will cover long-term care for the elderly who cannot afford it on their own.  A majority of nursing home residents use Medicaid to pay for their stay.

Before applying for Medicaid, you should contact the Medicare/Medicaid website.  The federal Medicare web-site is www.medicare.gov

Medicaid websites are state based so go to www.Medicaid”your state”

Sources:

www.medicare.gov

en.wikipedia.org/wiki/Medicare_

www.medicaid.gov