Ask anyone who writes about senior care or works in the industry and they’ll tell you there are a lot of misunderstandings about different parts of the senior care puzzle. Those of us who write for SeniorAdvisor.com hear a lot of them – and the problem with mistaken assumptions is that they can prevent people from getting help they need. So we’re using the blog to bust a few myths about senior care, with the hope that you can use this information to help your family make the most of the resources that are out there for you. Today’s myth is the common idea that Medicare and Medicaid are the same thing.
Medicare and Medicaid are two of the most important programs in American eldercare, but many Americans don’t know much about them. A surprising number of us mistakenly believe that Medicare and Medicaid are different names for the same program. Others assume they have to choose between Medicare and Medicaid when they retire. Some families leave valuable help on the table because they mistakenly think they or their parents don’t qualify for Medicaid.
The basic difference between the programs, as described by the US Department of Health and Human Services, is that Medicare is a health insurance program and Medicaid is a health assistance program. Some people who receive Medicare also qualify for Medicaid, but it’s not an either-or choice. And your parents may be eligible for Medicaid even if they own a nice home and car.
What does Medicare provide?
Medicare provides health insurance. The program is divided into several smaller parts that each have different benefits. Medicare Part A and Part B are also called Original Medicare. Together, they cover
- durable medical equipment
- home health care
- hospice care
- inpatient hospital care
- lab tests
- outpatient care
- physician services
- selected preventive services
- skilled nursing facility care for a limited number of days, under specific conditions
You also have the option to add Part D for prescription drug coverage. And yes, there’s a Part C. Part C is a Medicare Advantage plan that covers the same things as Parts A, B, and sometimes D. Unlike Original Medicare (Parts A and B), Part C plans are run by private insurers with Medicare approval.
As with most insurance plans, Medicare participants pay premiums and have copays. Medicare is the same everywhere in the US.
What does Medicaid provide?
For people who can’t afford to pay Medicare premiums and copays out of pocket—and for people who aren’t eligible for Medicare but who can’t afford private insurance—Medicaid can help cover costs. Unlike Medicare, Medicaid covers the cost of long-term assisted living and nursing home care, which is not covered by Medicare. The details of what Medicaid covers depend on where you live, because each state has its own eligibility requirements and services.
Who runs Medicare and Medicaid?
Medicare is run entirely by the US Department of Health and Human Services, through the CMS (Centers for Medicare and Medicaid Services). Medicaid, on the other hand, is jointly funded and run by CMS and each state’s health department. Although there are federal guidelines and standards for all Medicaid services, each state has the ability to tailor Medicaid services to meet its residents’ needs and the state’s budget.
Who is eligible for Medicare?
In general, people who’ve reached age 65 are eligible for Medicare. People younger than 65 may be eligible for Medicare if they have end-stage kidney disease or ALS (Lou Gehrig’s disease). People under 65 who’ve received Social Security or Rail Road Board disability benefits for longer than 2 years may also be able to enroll early in Medicare.
Who is eligible for Medicaid?
Medicaid eligibility rules vary by state. In general, Medicaid is available to families with low incomes and few assets besides a house and car, and those with certain disabilities. Medicare recipients may also be eligible for Medicaid. You can use the map tool at Medicaid.gov for details about eligibility, programs, and quality of services in your state.
Do Medicare and Medicaid pay for assisted living?
Medicare does not pay for assisted living. In some states, Medicaid recipients can use waivers to pay for assisted living if they need help with activities of daily living, like dressing, eating, and bathing.
Who pays for in-home care, Medicare or Medicaid?
Medicare pays for home health services if you meet several conditions. They include:
- being under a doctor’s care and following his or her care plan.
- needing part-time skilled nursing care and/or physical therapy, speech therapy, or occupational therapy.
- being homebound — unable to leave your house most of the time.
You also must also meet with your doctor in person and get your home health care from a Medicare-approved provider. Medicare’s booklet on home health care benefits covers the details.
Medicaid also pays for long-term in-home care for qualified seniors. Details vary by state.
Do Medicare and Medicaid pay for nursing home care?
Medicaid pays for long-term nursing home care in an approved facility. In fact, 60% of American seniors in nursing homes rely on Medicaid to cover the cost of their care. That’s because the average yearly cost of nursing home care is about $82,000, according to the Kaiser Family Foundation.
Medicare pays for short-term stays in approved skilled-nursing facilities for seniors who have been hospitalized for a minimum of three days and whose doctor certifies that they need skilled inpatient rehabilitative care.
Do Medicare and Medicaid pay for hospice care?
Medicare Part A provides at-home and inpatient hospice benefits. States may choose to offer Medicaid hospice benefits but they aren’t required to do so.
For more information on Medicare- and Medicaid-certified senior care options near you, talk with our experts at 1-800-805-3621.