Understanding Medicaid vs. Medicare for Long-Term Care
Understanding the difference between Medicaid vs. Medicare (Part 1.)For all practical purposes, the only governmental "insurance" plan for long-term institutional care is Medicaid, not Medicare. Medicare coverage for nursing home care is limited to full coverage for up to 20 days following a hospital stay of not less than three overnights. After that, Medicare will pay for a portion of up to the next 80 days, with the ill person responsible for $137.50 per day. With this limitation, it is understandable how Medicare ends up only paying for approximately 2% of all skilled nursing care in the United States. The result is that most people, unless they have planned ahead or have private insurance, pay out of their own pockets for long-term care until their funds drop to the level where they become eligible for Medicaid. While Medicare is an entitlement program, Medicaid is a form of welfare--or at least that's how it began. Therefore, to be eligible, you must become "impoverished" under the program's guidelines.
Private Paying for Nursing Home vs. MedicaidDespite the costs, there are advantages to paying privately for nursing home care. The foremost is that by paying privately, an individual is more likely to gain entrance to a facility of their choice, as opposed to facilities having "Medicaid Beds" available. The obvious disadvantage is the expense. In Florida, nursing home fees average $6,000 a month. Without proper planning, nursing home residents could spend the bulk of their savings paying for their care.
Therefore, you need to determine if this stay in a nursing care facility is temporary, as it would be for rehabilitation services or if it will be a long-term or permanent placement and then decide if your financial resources would make it possible to afford the costs of long-term care or if you will need to consult an Elder Law attorney about engaging in Medicaid Planning.
Nursing Home Care vs Assisted LivingIf an individual is unable to live independently, but does not require a nursing home level of care, he or she can reside in an adult congregate living facility known as an Assisted Living Facility or ALF. For most individuals, the cost of care in such a facility (ranging from $2,000 - $5,000 per month) is paid for out-of-pocket, unless they have long-term care insurance covering that level of care. Generally, Medicaid is not available for an ALF residence. However, recently, the State has opened Medicaid assistance to a number of individuals who are ALF residents on a limited basis. One program is called the "Medicaid Waiver Program," the other program is known as the "Community Diversion Program." Please discuss these programs with an Elder Law attorney if you are seeking assistance with in-home care or ALF care as opposed to skilled nursing care.