Justin, My mother’s physician is recommending that she go to a nursing home because of her declining mental health. My friend went through a similar experience last year with her father. He broke his hip and had to move into a nursing home. Medicare benefits paid for her father’s nursing home stay and it did not cost him a thing. Do we need to look into Medicaid planning or will Medicare cover her expenses? – Renee
Renee, The Medicaid system is complex and often illogical, so it is no surprise that it generates many myths. People wrongly believe that the Medicaid and Medicare systems are essentially the same program with no major differences in the benefits they provide. Medicare is like traditional health insurance, insuring people age 65 or older without regard to finances. It can pay for diagnostics and treatments, hospital bills and medications, but it only provides for rehabilitation in a nursing home, not a long-term care stay like your mother will need. For the first 20 days Medicare will cover the full cost of rehabilitation. It can partially cover up to 80 additional days at most, if medically necessary, but then it pays nothing.
In contrast, Medicaid is the primary payer for long-term care services like nursing home care. To obtain Medicaid an applicant must adhere to strict financial rules. It is better to plan far in advance for Medicaid qualification, but even when a person is about to enter a nursing home there is still time to plan to save significant assets