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Medicaid vs Medicare

Medicaid vs. Medicare

While they are often confused with each other, it is important to understand a critical difference between the two. Medicare is short term care that is broken down into four main “parts”:

  • Part A: Hospital/Hospice Insurance
  • Part B: General medical insurance
  • Part C: Medicare Advantage. This is an HMO. Medicare Part C is elected instead of Part A & B and typically provides more services, including prescriptions. Usually covers the 20% not covered subject to co-pays/deductibles.
  • Part D: Prescription Drugs. Pays initial deductible and when certain thresholds are reached there is the dreaded “donut hole.”

What is Long Term Care?

Long Term Care (LTC) is medical care in Nursing Homes, Rehabilitation Centers, Assisted Living Facilities, and care at home (or In-Community Care).

Doesn’t Medicare cover Long Term Care?

Unfortunately, Medicare was designed to provide healthcare coverage, much like your healthcare insurance carrier, such as Blue Cross Blue Shield. Medicare will pay for your hospital visits, prescription drugs (with a donut hole), doctors visits, and such. Medicare will NOT pay for an Assisted Living Facility, Nursing Home, Rehabilitation Center, In-Community assistance. That is left to either self-pay, LTC insurance, or Medicaid.

We realize this can be confusing. Medicare will pay up to 21 days in a Rehabilitation Center, and then the patient is responsible for approximately $150 per day of the costs up to 100 days. This is really not a solution though, given the expensive daily cost.

What does Medicaid Cover?

Medicaid will cover ALL of the costs of a Rehabilitation Center or Nursing Home, for as long as the patient needs those services.

Medicaid will also pay for the Level of Care in an Assisted Living Facility, up to $1200, as well as up to 40 hours per week for a home health aide.

Of course, Medicaid would also pay for all medical care, including prescription drug costs, thus eliminating the dreaded “Donut Hole”.