As Elder Law Attorneys, we are asked, “What the difference between Medicare and Medicaid?”
Simply put, Medicare is health insurance for Americans over the age of 65 and Medicaid is the government assistance program available to pay nursing home, assisted living or in-home care costs for Americans over the age of 60.
Medicare pays for doctor visits, hospital stays and short-term rehabilitative nursing home stays with a maximum of 100 days. Medicare also pays for Hospice services for a person who is in the last six months of their life.
To get Medicare to pay for the rehabilitative stay in the nursing home, the person needs to have been admitted to the hospital for three “midnights” AND require the skills of a nurse upon entering the facility. This need would include rehabilitation or having a breathing or feeding tube.
Medicaid also pays for prescriptions, copays that insurance and Medicare do not cover and incontinence supplies.
To qualify for Medicare, a person needs to be 65 years old or have been on SSDI for at least two years.
To qualify for Medicaid, a person needs to be over that age of 60 and require assistance with at least two of the activities of daily living, such as: eating, dressing, bathing, getting in and out of bed or a chair, going to the bathroom or personal hygiene. A person in a nursing home is presumed to meet this requirement and someone in Assisted Living or at home requires an assessment by the Area Agency on Aging.
If you’re contemplating the difference between the two programs, you’re likely at the point where someone you love is entering a nursing home or needing in-home care. This time can be a very confusing and trying time. For immediate help, please consult the elder law attorneys at AlerStallings LLC to help navigate the challenging Medicaid process.