Medicaid Eligibility & Medicaid Asset Protection

Difference between Medicare & Medicaid

Medicare and Medicaid are two entirely different programs:

  • Medicare is a government health insurance program for people over 65 and for those who are on Social Security disability.
  • Medicaid is funded jointly by the Federal Government and the individual states. Individuals must meet specific financial and “need for care” requirements in order to receive medicaid benefits.
  • Medicare qualification is based on age and/or disability. Participation not subject to income, asset or “needs” test.
  • Medicaid qualification is based on “need for care” and financial need. Single (unmarried) individuals must be essentially broke (below $2,000 in most states). Rules allow certain strategies to protect assets from Medicaid.
  • Medicare provides coverage for hospitalization, doctors and other types of medical expenses. Medicare is a medical insurance program, and except for a limited short-term nursing home benefit, is not coverage for nursing home or other long-term care.
  • Medicaid provides benefits for long-term nursing home care, and, in many states, benefits for other types of long-term care.
  • In order to get Medicare coverage for a nursing home stay, you must be in an approved skilled nursing facility, have been in the hospital for at least three days prior to entering the facility, and to be deemed by Medicare to be medically benefiting from that skilled nursing. Custodial care is not covered. Technically, there is a maximum of 100 days of nursing home benefit. In actuality, the requirement about medically benefiting usually limits the benefit to a period of 10-20 days for rehabilitation.
  • Those individuals who meet the definition of “need for care,” as well as the financial requirements, can qualify under Medicaid for nursing home care (including custodial care). There is no maximum limit on the period of time that care can be provided.
  • Under no conditions does Medicare pay for assisted living, residential care facilities, and adult foster care.
  • In many states, Medicaid will provide care in assisted living, residential care and/or adult foster care facilities.
  • Except during the time you're in the hospital, Medicare does not cover medications.
  • Medications are covered by Medicaid.
  • Medicare does have some benefit for home health but this is purely for medical reasons, not for caregivers to come in and attend to someone who needs help with personal needs on a long-term basis.
  • In many states, in-home care is provided with Medicaid to allow for caregivers to come into the home to provide care and help with personal needs and activities of daily living.

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Medicaid Eligibility | Medicaid Asset Protection | Medicaid Qualification

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