Medicare and Medicaid- What Do They Cover?

September 30, 2011

The following information comes from Bill Hammond- Elder Care Attorney in Kansas City- Medicare and Medicaid- They sound similar, right? Well, unfortunately many people fail to realize the differences between the two, which makes for big problems in the future. Surprisingly, most people think Medicare will "care" for them forever. Unfortunately, that's not the case. When a friend of mine began his career as an elder law attorney, he was surprised at how few people knew the truth about Medicare and nursing home benefits. In fact, his own mother asked him one day, "Why are you focusing in the area of Medicare and Medicaid? There can't be any money to be made helping people with those issues." His mother is a very bright person, but even she did not understand the limitations of Medicare and what it would and would not pay for if you need to live in a nursing home. Medicare and Medicaid sound similar, but are totally different programs. And for ANY senior, it’s vital to know the difference. Your future depends on it! Medicare provides healthcare benefits for the over 65, blind, and disabled; while Medicaid provides medical benefits for the impoverished. Medicare is primarily a type of public health insurance for those age 65 and older. In essence, it is their primary health insurance coverage. Many seniors are unaware that Medicare does not pay for long term care - it's excluded! The confusion is easy to understand, because Medicare does pay for rehabilitation. So, if a senior citizen is enrolled in the traditional Medicare plan and is hospitalized for a stay of at least three days, and is then admitted into a skilled nursing facility, Medicare may pay - for a while. But once those Medicare benefits hit 100 consecutive days, you've hit the maximum. And while we're being frank, Medicare may not even cover you for the full 100 days - it's based on the patient's response to the rehabilitation. There must be some actual improvement, otherwise Medicare will decide that the condition is a long term care need and they'll cut you off. Medicare really only cares about you if you can get better. Since diseases like Alzheimer's and Parkinson's have no known cure today, rehabilitation is not possible - and Medicare isn't going to pay for nursing home care for you if you have Alzheimer's or Parkinson's or a similar disease. Unlike Medicare, few of us have any experience in dealing with Medicaid rules and guidelines. Medicaid is paid for by both federal and state funds but is "administered" on a state level. That means the federal government covers between 50-80% of the program costs within the state, and the state pays the rest. Therefore, rules can vary from state to state (even county to county) rather dramatically. EVERY reader of this report should understand the differences between Medicare and Medicaid. The information below is designed to contrast the two programs: ***Medicare*** -Health insurance for seniors age 65+ -Federally controlled, uniform application across the country -Pays for no more than 100 days of nursing home care -Pays for primary hospital care and related medically necessary services -Must have contributed to Medicare system to be eligible and generally be over age 65 ***Medicaid*** -Needs-based health care program -Controlled state by state, which created different regulations in each state of application -Pays for long term care -Pays for medications -Must meet income and asset limits to be eligible and be over 65, disabled, or blind So, as you can see, Medicare is health insurance, and Medicaid is public long term care coverage - but often there are stages in between that require examination and discussion. Don't get caught off guard by the surprising differences in these two programs. The people in charge don't seem to be able to keep it simple. William G. Hammond, J.D. The Elder & Disability Law Firm, P.A. 9225 Indian Creek Pkwy., Suite 1100 Corporate Woods, Building 32 Overland Park, KS 66210 (913) 850-6251 whammond@senioradvocates.net www.KCElderLaw.com The choice of a lawyer is an important decision and should not be based solely upon advertisements. Legal Disclaimer This information has been provided for general informational purposes only. It does not constitute specific legal advice. Do not take any action based on your understanding of the legal concepts presented in this letter except to call a qualified elder law attorney. The receipt of this information does not establish any attorney-client privilege. Proper legal advice can only be given upon consideration of all the relevant facts, circumstances, and laws. Copyright 2009-2011 Netbizkidz LLC.