Updated: Apr 18
Medicare is a federal entitlement-based program. In general, Medicare provides health insurance coverage for (1) people who are 65 or older, (2) certain younger people with disabilities, and (3) people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).
Medicare has four main parts:
Part A – Hospital and Hospice coverage;
Part B – General medical coverage (monthly premium);
Part C – Medicare Advantage (monthly premium), which covers more services including prescriptions (subject to co-pays and deductibles); and
Part D – Prescription Drugs (monthly premium).
Medicare has no income or asset limitations associated with qualification, but it does consider other eligibility requirements (depending on which Medicare Parts are being sought), such as citizenship and residency status, whether the applicant has paid into the system for at least 10 years, whether Social Security Disability Insurance (SSDI) benefits are being collected, and more.
Notably, Medicare does NOT pay for long-term care such as permanent relocation to an assisted living facility or nursing home. Medicare will only provide coverage for the rehabilitation phase of your recovery, and does so for a very limited number of days. Moreover, the longer the rehabilitation takes, the more daily co-pay you will have to pay. Once you are deemed no longer in the rehab/recovery phase, Medicare will stop covering your nursing home care.
On the other hand, Medicaid WILL pay for long-term care at nursing homes and assisted living facilities beyond the rehabilitation phase for as long you stay at the facility. Unlike Medicare, Medicaid is a need-based program, not an entitlement program. Medicaid eligibility is based upon qualifying medically as well as meeting strict income and asset tests.
At its core, Medicaid exists to protect the elderly against the exorbitant costs associated with long-term care. Medicaid benefits include covering nearly the full cost of a nursing home bill and/or a large percentage of an assisted living facility bill (subject to a “patient responsibility” amount) as well as benefits to cover a portion of the costs of in-home care. A proper Medicaid plan prepared by an Elder Law & Medicaid Planning lawyer can get you qualified for Medicaid long-term care benefits, even if initially you do not pass the assets and income tests.
Our law firm focuses on “Crisis” Medicaid Planning (when you need long-term care coverage now) and “Proactive” Medicaid Planning (when you plan for Medicaid eligibility before you need the benefits). Whether you need long-term care assistance now or want to be prepared for the future, you should consider your options without delay. Time is of the essence, and failure to plan is planning to fail.
By contacting our attorneys, we can provide a comprehensive analysis of your situation to determine what steps are needed to qualify you for Medicaid benefits. There is no “one size fits all” solution when it comes to long-term care, so the sooner you get your affairs in order the more effective counsel can be in qualifying you for Medicaid benefits.