Medicare or Medicaid?

Medicare or Medicaid? What Medicare Will Cover and When to Apply for Medicaid

Picture this . . . Susie, who is 82 years old, fell, broke her hip, and was taken to the hospital. The hospital then discharged her to a skilled facility for rehab. Now, after about 6 weeks, the facility is ending Susie’s rehab and she still isn’t well enough to come home. It’s clear that she needs to stay in the nursing home for long term care. What is Susie’s family to do? What are their options? Will Medicare or Medicaid cover the cost of her care?

The reality of stories like this one . . .

Unfortunately, at Hurley Elder Care Law, we hear stories like this quite often, and there are many misconceptions about what Medicare will pay for and when it’s time to explore Nursing Home Medicaid. Susie’s family is surprised to find out that Medicare does not pay for long term care. We find it is quite common for our clients to assume Medicare will pay for nursing home care and were not aware of Medicaid planning.

What is the difference between Medicare and Medicaid?

Medicare is health insurance, and most seniors have coverage through some form of Medicare. For more Medicare information, click here and here. Medicaid, on the other hand, pays for long term care in the nursing home.

How do Medicare and Medicaid work together in situations like this?

Medicare health insurance will pay for the hospital stay, and after a three-day hospitalization, Medicare will cover the first 20 days of rehab at no additional cost. For more on the three-day rule, click here. Medicare can also cover up to 100 days of skilled care but this coverage comes with a few caveats.

Many people believe that the 100 days of rehab are a sure thing, but they are not.

In reality, Susie can get up to 100 days of rehab, but if she stops progressing (as seen in our story), Medicare can stop paying. Even if Susie had gotten the full 100 rehab days, Medicare will not continue to pay for long term care in the nursing home.

People also believe that Medicare covers all of the costs of rehab care. There is generally a co-pay assessed for days 21 through 100. Supplemental health insurance can help offset this cost, but when Medicare stops paying, Medicaid may be the only option to afford the high cost of nursing home care. For more information on Medicaid in Georgia, visit our website here or call us at 404-843-0121.