Understanding Medicare & Medicaid

Medicare & Medicaid

70% of people over age 65 will need some type of long term care during their lifetimes.1 Generally, health insurance doesn’t cover those expenses, nor does Medicare. Medicaid may provide some coverage but only for lower-income Americans.

Medicare: The Facts

Medicare is the federal health insurance program designed primarily for people aged 65 and older. Adults with certain permanent disabilities or medical conditions may qualify for coverage at a younger age.

Medicare Part A is hospital insurance that covers portions of a hospital bill for inpatient hospital care, hospice care and limited time in a skilled nursing home facility. Deductibles, coinsurance and copayments will generally need to be paid even if Medicare covers the service. Medicare does not pay for homemaker services.

Medicare will pay for services once the following conditions are met:

  • You had a recent prior hospital stay of at least three days.

  • You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay
    (not all facilities are Medicare-certified).

  • You need skilled care such as physical therapy or skilled nursing services.

If you meet ALL of these conditions, Medicare will pay 100% of your costs for the first 20 days. For days 21-100, you pay your own expenses up to $204 per day and Medicare pays any balance. After 100 days, you are fully responsible for the entire cost of your care for each day you remain in a skilled nursing facility.2 This is not a comprehensive list of Medicare resources and/or criteria that may be required to meet eligibility. For a complete list of what Medicare covers, please visit this website.

Medicaid: The Facts

Medicaid is a joint federal and state public assistance program for financing health care for low-income people. It pays for health care services for those with low incomes or very high medical bills relative to income and assets. It is the largest public payer of long-term care services.

Medicaid pays for certain health services and nursing home care for people with low incomes and limited assets. Eligibility is usually based on income and personal financial resources. So, to qualify for Medicaid you may have to spend down your assets. It's important to know that Medicaid benefits may vary by state. To find out the eligibility requirements in your state, visit this website.

Next Steps: Plan for Long Term Care

206401A3B 04/24/24