When most people think of long-term care, they imagine nursing homes or assisted living facilities. However, there are several different options available for long-term care. The most common is nursing home care, where an individual moves into a nursing facility and receives medical care and daily assistance. There are also community-based services, such as adult daycares and home meal delivery services. These community services assist individuals with daily tasks that they have become unable to perform. Another option is home-based care. This allows you to remain in your home and receive care services there. Although these options vary widely, they have one thing in common: the expense.
As individuals age, they begin to think about how they will pay for long-term care. Many do not know whether Medicare or Medicaid cover these services. Medicare is a federal health insurance program for individuals over 65, individuals under 65 who have certain disabilities, and all individuals with end-stage renal disease. Medicaid is a federal and state insurance program for individuals with low incomes and few assets. Medicaid eligibility and services varies state to state, while Medicare has the same standards and requirements for all U.S. citizens.
Medicare typically only covers medically necessary care, such as medication, doctor visits, and hospital stays. It also will assist you with short-term care if you are likely to recover from the illness or injury. For example, Medicare will pay for physical therapy after you fall and break your hip because you are likely to recover. Medicare does not cover care that assists you with daily tasks, like bathing, dressing, and eating.
Medicare can cover some short-term care costs, like skilled nursing facilities, hospice care, and home health care if you meet the following conditions: (1) you have a recent three-day hospital stay, (2) within 30 days of your hospital stay you are admitted to a Medicare-certified nursing facility, and (3) you need skilled care. If you meet these three requirements, Medicare will pay for all of your costs for the first 20 days of your stay and will pay for a maximum of $140 per day for the next 70 days.
Medicare will also cover the cost of short-term care if your doctor deems that the care services are medically necessary. This can include intermittent nursing care, social services, physical therapy, and medical supplies. Medicare does not limit the amount of time during which you can receive these particular services.
Medicare will also cover hospice care, but only if you are not expected to live more than six months. Under Medicare funding, you can receive hospice care wherever you are living, including your home, a nursing home, or a hospice facility.
As stated above, Medicaid is a joint state and federal government insurance program. Rules regarding eligibility are largely governed by federal law, but states have significant latitude in operating their respective programs. Federal law mandates that Medicaid must cover certain individuals and offer certain services, but states are free to add additional groups to be covered and services to be provided.
Medicaid, unlike Medicare, will cover long-term care costs. However, even if you do qualify for Medicaid, this does not necessarily mean that you will qualify to receive long-term care. There is a second level of inquiry to determine whether you are eligible for long-term care. Generally, states will evaluate the amount of personal care services you will require to determine whether you qualify to receive long-term care.
For those that qualify, Medicaid will cover nursing home services, community-based services, and home-based services. Medicaid will help you stay in your home for as long as possible by providing case management services, but they will not help pay for your rent or mortgage in order for you to stay in your home.
Overall, Medicaid is the better option for covering long-term care costs. However, not everyone will qualify financially for Medicaid. Further, your ability to qualify for Medicaid will vary state to state.
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