There are key points on the difference between US Medicare and Medicaid in the US. This article provides an overview of health insurance coverage for long-term care services.
Eligibility
- Medicare is accessible to most US citizens and permanent residents aged 65 and over. Individuals under the age of 65 who have certain disabilities or end-stage renal disease (ESRD) qualify.
- Medicaid eligibility varies by state. The program qualifies low-income individuals and families, pregnant women, and children. Elderlies and individuals with disabilities are eligible as well.
Health Insurance Coverage
- Medicare provides coverage for hospital care.
- Medicaid offers more health services. This includes doctor visits, hospital stays, and long-term care. Preventive care and mental health services are included under Medicaid, too. Consult with an agent to know the state-specific Medicaid programs.
Costs
- Medicare’s should be ready to pay for premiums, deductibles, coinsurance, and copayments.
- Medicaid provides coverage at low or no cost to qualifying individuals. Most states subsidize the majority of expenses. Some Medicaid programs may require small copayments for specific services.
Long-Term Care
- Medicare covers just a limited coverage of skilled nursing facility care after a hospitalization. It does not often cover long-term care services.
- Medicaid provides a wider range of long-term care services. Coverage includes nursing home care and home- and community-based services. This is available to eligible individuals who satisfy the program’s requirements.
Nursing Home Care
- Eligibility for Medicaid requires individuals to meet income and asset limits.
- Medicaid covers nursing home care for eligible individuals who cannot pay for it themselves.
- Medicaid nursing home coverage include room and board, medical treatment, therapies, and some personal care services.
Assisted Living Services
- Some states provide Medicaid waivers or Home and Community Based Services (HCBS) programs. They support specific long-term care services and assisted living facilities.
- Eligible individuals may get support with activities of daily living, personal care services, medication management, and transportation. It allows them to stay in assisted living or community-based settings and not in nursing homes.
Eligibility and coverage for long-term care services vary. Consult with a Medicaid planner or elder law attorney for guidance on eligibility criteria and available long-term care benefits in your state.