Some Misconceptions about Medicaid and Medicare

Medicaid

Medicaid pays for health services for the very poor of any age. Qualifications for Medicaid vary by state, but generally the law says you must first spend down to the poverty level, using up all but about $2,000 of your assets.

Being eligible for Medicaid does not guarantee placement in a nursing home. There may be long waiting lists for Medicaid-funded facility care. Medicaid patients often receive lower-quality care and they do not have the control or say in the selection of the facility that provides this care like those who can pay for their care on their own. Under Medicaid, nursing home care is virtually the only option. Home care, assisted living facility care, adult daycare, outpatient services, and alternate caregiver services are not usually reimbursed under Medicaid and are, therefore available only to those who can pay for these services on their own.

Medicare

Medicare pays for health care for people 65 and over and for those who are disabled. Medicare does not pay for long-term medical service such as assisted living, adult day care or almost all nursing home care. Medicare pays only the first 100 days of skilled care, such as physical therapy or nursing and then only after a hospital stay, which only accounts for 5% of all long term care costs. The personal care must relate to the treatment of an illness or injury and not just assisted living care.

Medicare supplement insurance is private insurance that helps pay for some gaps in Medicare coverage. Plans D, G, I, and J pay up to $1,600 per year for services to people recovering at home from an illness, injury or surgery.