Facebook
Twitter
Messenger
Messenger
Facebook
Twitter

Health Insurance Coverage: US Nursing Home Or Assisted Living

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.

Facebook
Twitter
Messenger
Facebook
Twitter
Messenger