The terms Medicaid and Medicare sound similar, and indeed these two assistance programs have features in common; they both cover costs of healthcare for older adults. But they are quite different when it comes to eligibility and how the programs work.
Medicare is generally available to US citizens and permanent residents in every state at the age of 65. Medicare provides short-term coverage for medical needs such as physician visits, hospitalizations, outpatient services, prescription medications, medical equipment, and rehabilitation (for instance: following knee replacement surgery, or when recovering from a stroke or heart attack.)
Medicare often involves co-pays and deductibles, which can accumulate quickly. And Medicare does not pay for long-term custodial care, referring to medical and living assistance for someone who is physically or mentally (cognitively) dependent on others for the rest of their lifetime. For these individuals who require advanced and ongoing help with healthcare and daily living activities, a skilled nursing facility (also known as nursing home) is sometimes necessary.
Medicaid is the primary payer for nursing homes, covering more than 60 percent of all nursing home residents, according to the American Health Care Association (AHCA.)
To be eligible for Medicaid to cover the costs of long-term care, a person must meet both medical and financial criteria set by federal and state governments because Medicaid is funded jointly at federal and state levels. This is one of the complications of applying for Medicaid; the applicant must follow the guidelines of the state in which the Medicaid recipient lives.
Another time-consuming task in applying for Medicaid is proving the need for financial and medical assistance. This involves paperwork and documentation such as house deeds, marriage and divorce certificates, income, bank accounts, and more.
For many middle-class individuals who live a long life and require help, Medicare benefits run out, leaving many individuals and their families to face difficult financial decisions. Some, but not most, people have access to continued healthcare coverage through a secondary policy from a pension or retirement package, or a long-term care insurance policy they have paid into. Some people have plenty of money to pay out of pocket. But for a vast number of middle-class Americans without substantial savings or assets, Medicaid is a solution to gain access to necessary medical care, services and residential options without draining the financial nest egg of the individual’s adult children.
Families exploring Medicaid to pay for long-term care for a loved one may have heard other names for the program, such as Title 19, or state program names such as MassHealth in Massachusetts, New Jersey Family Care in New Jersey, or Medical Assistance in Pennsylvania, Rhode Island and other states.
Preparing in advance for potential financial ramifications of “old age” often requires assistance from a financial advisor or an elder law attorney. If and when it comes time to apply for Medicaid, NavigAid offers a “do-it-yourself with assistance” approach using an online tool that provides structured organization and support. NavigAid helps to eliminate errors in the application process, increasing the likelihood that the application will be submitted correctly and completely, leading to a faster acceptance for eligible individuals. To learn more, visit www.mynavigaid.com.
Ben Mandelbaum is founder and CEO of NavigAid, an online tool that assists with the Medicaid application process to access affordable long-term care for a loved one.
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Assessing and obtaining eligibility for Medicaid sometimes requires legal advice and the assistance of an attorney. NavigAid does not provide legal advice or services. You may wish to consult with an attorney concerning your Medicaid eligibility and application.