Medicare & Medicaid Misconceptions

People routinely get the programs and terms Medicare and Medicaid confused; and thinking they have the same coverages with both.  However, this is not true. One of the most common misconceptions is Medicare will pay for long-term care. Medicare is an entitlement program.  If a person is on disability or is receiving Social Security benefits at age 65, they will receive Medicare benefits.  Medicare will only pay, through Part A, up to 100 days of skilled and long-term care. After the first 20 days, a co-pay of $194.50 is charged for days 21–100 (if coverage is approved by Medicare).  Generally, this is covered by a Medigap insurance policy.  Because of the strict standards, most patients rarely get the full 100 days of coverage.  In general, Medicare will not pay for most of long-term care for home services or nursing home services and expenses beyond the 100 days or less that are covered by Medicare.  Medicare rarely pays for custodial care.  The general exception to this really is doctor-prescribed medically necessary treatment for illness, injury, or condition such as needing physical therapy or skilled nursing care on a part-time or intermittent basis.  If these services are medically documented, every 60 days, Medicare will cover such services.  Also, Medicare can cover hospice care if you have a terminal illness and have a life expectancy of less than 6 months, or less. 

Medicaid is the default and commonly used program now for long-term care after Medicare coverage runs out.  Most Americans today in nursing homes are enrolled in Medicaid to pay for their costs.  In order to do so, there are income and asset limits that must be satisfied.  You can obtain Medicaid for paying for long-term care in a nursing home or home care beyond the basic initial Medicare coverage. 

Most people and family members falsely believe they must exhaust all their hard-earned savings before Medicaid will pay for their long-term care.  This is a common misconception. To be eligible for Medicaid coverage, there are legal techniques to protect hard-earned asset even if gifting, or transfers to properly drafted irrevocable trusts for more than 5 years have not been already put in place.  This is commonly called the “look-back” period of whether gifts and transfers will be penalized by the Medicaid program to delay benefits for long-term care coverage. 

Please consult with an elder law attorney if you, or loved one, needs care at home or for the long-term, and discussion of your legal options to protect your savings.