Confused About Medicare and Medicaid?
Updated: Mar 31
Medicare becomes a person's healthcare insurance when they turn 65. It pays for doctor visits, prescriptions, hospitalization, emergency care, and rehabilitative care. It pays for skilled medical care that stabilizes, improves, or cures the patient's condition. Once skilled care is no longer needed, but the patient is not independent with activities of daily living, then the patient's care becomes custodial in nature. Medicare does not pay for custodial care.
Where Medicare stops, Medicaid picks up. Bear in mind that there are many different Medicaid programs. The program I am writing about is Long Term Care Medicaid ("LTC Medicaid"). It pays for custodial care. The patient must apply for LTC Medicaid. Approval of the application is dependent upon satisfying the medical and financial requirements.
The primary qualification requirement is medical, not financial. The applicant must require assistance with at least one activity of daily living. If not, the application is denied. This is why LTC Medicaid is a benefit for the disabled, not the indigent. Yes, if the applicant qualifies medically, then there are financial limitations on assets and income that vary depending on whether the applicant is single or married.
Contrary to popular belief, an applicant does not have to become indigent in order to qualify financially. Various types of assets are not included in the asset calculation. There are exceptions to the general financial rules that allow the applicant to spend down to the financial limit with out consuming all of their money on the purchase of goods and services. In fact, a single applicant can protect up to 60% of their excess assets, and a married couple can protect almost all of their combined assets, and still qualify.
The key is the medical need for assistance with activities of daily living. When this occurs it is time to explore with an Elder Law attorney whether LTC Medicaid can work for your family. You have to apply for Medicaid in order to protect assets. Please don't wait until all of your assets are gone.