MEDICARE vs MEDICAID
Medicare and Medicaid, although they sound similar are as different as night and day.
Medicare is given to people age 65 and older or people who have been disabled for 2 years. It is entirely a federal program.
Medicare covers nursing home charges on a short term basis for a maximum of 100 days for “skilled” nursing care. A patient needs to meet certain criteria in order to remain on skilled benefit.
Medicare is a program which expects you to pay co-insurance amounts which go up each year and is usually covered by a Medicare supplemental insurance if you have that type of coverage.
Medicaid is a federal program but is state regulated in that each state has their own rules and regulations.
Medicaid covers long term nursing home charges in most skilled nursing facilities for those who qualify. There is also coverage for care in some assisted living facilities and for at home care, although funds for those programs are limited.
Recipients of Medicaid benefits must be disabled or 65 years of age in order to qualify.
Applicant for nursing home Medicaid coverage usually must pay all but $105 of their monthly income. Exceptions include examples where there is a community spouse who needs some of the nursing home spouse’s income to meet shelter expenses at home.
Medicaid also now allows a recipient to keep enough income to pay for their Medicare supplement coverage, in addition to any other health insurance or dental premiums.
When a Medicaid recipient resides in a nursing home there is a patient responsibility that is due to the facility. This amount is calculated by the Medicaid caseworker at Department of Children and Families. It is based on GROSS income prior to any deductions that may be coming out of the income sources such as insurance premiums, tax withholding, union dues, etc.
From the gross income amount, the caseworker subtracts any health or dental premiums in addition to $105 personal needs allowance. The final net amount equals the Medicaid recipients monthly patient responsibility due to the facility.
If the Medicaid recipient has a spouse living in the community, that spouse may be entitled to keep some or all of the Medicaid recipient's income. The community spouse's income and shelter expenses will need to be provided in this case.