Whenever I meet with clients to discuss Medicaid planning, I often hear the same response: “I already have that—you mean Medicare, right?” It’s a common misconception, and understandably so. Both Medicaid and Medicare are government-sponsored health insurance programs, but they serve very different purposes. Knowing the distinction is especially important when it comes to long-term care, as it can quickly deplete savings if not adequately planned for.
Medicare: Coverage with Limits
Medicare is a federal health insurance program primarily based on age. Most people become eligible at age 65, though younger individuals with specific disabilities may also qualify. Medicare is designed to cover short-term medical needs—think hospital stays, doctor visits, rehabilitation services, prescription drugs, and some home health care.
However, Medicare’s coverage has significant limits. For example, if you require rehabilitation after surgery or a hospital stay, Medicare will cover the costs—but only as long as you are showing signs of improvement. Once you plateau in your progress, Medicare will stop paying, even if you still require assistance.
Crucially, Medicare does not cover the cost of long-term care, including extended nursing home stays or ongoing assistance with daily activities such as bathing, dressing, and eating. Many families don’t realize this until they receive a staggering bill for nursing home care.
Medicaid: The Safety Net for Long-Term Care
Medicaid, on the other hand, is a joint federal and state program that provides health coverage to individuals who meet specific financial eligibility requirements. Unlike Medicare, Medicaid covers long-term care costs, including home health aides, assisted living, and nursing home care.
In New York, where nursing home costs can easily exceed $15,000 per month, Medicaid often becomes a vital resource for families. Without it, paying for long-term care out of pocket could quickly deplete a lifetime of savings.
The challenge is that Medicaid eligibility is based on both income and assets. Many people assume they won’t qualify because they own a home or have savings. However, with proper planning guided by an elder law attorney, it is often possible to legally protect assets while still qualifying for Medicaid benefits.
The Role of Elder Law Attorneys
Elder law attorneys assist clients in navigating the complexities of Medicaid eligibility and long-term care planning. This might involve creating trusts, transferring assets, or restructuring financial resources to ensure compliance with Medicaid’s rules while preserving as much as possible for the client and their family.
At Miller & Miller Law Group, we understand the stress families face when a loved one requires long-term care. Our goal is to help clients secure Medicaid coverage, easing the financial burden while ensuring they continue to receive the quality care they deserve.
Why Understanding the Difference Matters
In summary:
- Medicare is primarily for short-term medical needs and does not cover long-term care.
- Medicaid is income- and asset-based, but covers long-term care costs.
Understanding the distinction between the two can make all the difference in planning for the future. If you or a loved one may need long-term care, it’s essential to start planning now rather than waiting until a crisis occurs. Medicaid planning can help protect your assets, preserve your family’s financial stability, and ensure access to the care you need.
Ultimately, Medicare and Medicaid are not interchangeable. Medicare provides essential medical coverage as you age, but when it comes to long-term care, Medicaid is often the program that families must rely on.
Contact us today for long-term care planning. Be sure to mention this article during your consultation so we can focus on your specific concerns and guide you with personalized advice.
This article is a service of Miller & Miller Law Group. We do not just draft documents; we ensure you make informed and empowered decisions about life and death for yourself and the people you love.
