Medicaid is very different from Medicare. Understand the basics here.
What exactly is Medicaid?
Medicaid is a joint Federal and State program that helps pay for the medical costs of people with limited income and resources. The simplest way to start understanding the differences is as follows: Medicare is regular health insurance and short-term rehabilitative care.
Please Note: We are not licensed or able to advise you on Medicaid claim strategies. It is our hope that the content on this page provides you with basic information and direction. We suggest you reach out to your local Geriatric Care Manager, Elder Law Attorney, or CPA, for specific advice to your specific situation armed in hand with the basic direction provided on this page.
While Medicaid can serve as ongoing health insurance for younger individuals, when it comes to older adults, Medicare takes care of that. Medicaid for older adults is frequently a resource for long-term care with medical needs such as those needs served in a Nursing Home.
Medicaid does not pay for private-pay senior housing and retirement communities where medical care is not provided. In such communities, even if medical care is provided, sometimes Medicaid is not accepted.
Many people think Medicaid covers a loved one’s long-term care. The answer is, it sometimes does. But sometimes it may not.
Medicaid pays for long-term care with medical needs. It frequently will not cover the cost of most available units in a retirement community or assisted living community. Some assisted living communities are required by states to have a certain number of Medicaid paid-for units. That number is typically small with long waiting lists. Even when a loved one needs nursing home care, Medicaid coverage can be tricky and there may be long waiting lists for a Medicaid bed in a nursing home that accepts Medicaid as a matter of course.
To qualify for Medicaid and medically provided nursing home care, there are an asset and net worth tests.
To qualify for Medicaid in a nursing home, there are maximum asset tests that are applied. Frequently one is not eligible for Medicaid until a certain amount of their assets have been spent down on care already. While there are attorneys that could assist you with strategies to maximize your eligibility, Medicaid has learned over the years about those strategies and applies “look back” provisions to asset statements. Many states also seek reimbursement of paid Medicaid benefits from one’s estate and even children. When studying if Medicaid is right for you, we recommend you speak with professionals.
Medicaid is complex. Frequently Elder Law Attorneys or Geriatric Care Managers can help.
If you are able to pay a few hundred dollars for an hour or two of advice from a professional that specializes in the ins and outs of Medicaid, we highly recommend you do so because Medicaid information varies by state so widely. Find a local Elder Law Attorney or Geriatric Care Manager, for some initial direction on if and how Medicaid can apply to your situation. Note that Geriatric Care Managers are also referred to as Aging Life Care professionals.
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