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Medicare v. Medicaid - A long-term care perspective

Based on the similarity of their names, confusing Medicare with Medicaid is easy. However, there are stark differences between what the programs provide to their respective participants.

Medicare is a national health insurance program for which most people 65 years of age and older can qualify. It is most notably known for its difference coverages: Part A (hospital and other outpatient services), Part B (physician visits), and Part D (prescription drugs). With respect to long term care coverage, Medicare will only pay for a stay in a nursing home care provisionally after a hospital stay of at least three days. In a best case scenario, Medicare will cover up to 100 days of skilled nursing facility care for rehabilitation.

Medicaid, on the other hand, is a public benefit or entitlement program that is primarily funded by the federal government and administered by each state. Medicaid is known as MassHealth in Massachusetts. Upon qualification both financially and medically, Medicaid will pay for long-term care in a nursing home for as long as the resident requires said care. If eligible for Medicaid, the nursing home resident will only be required to pay his or her monthly income to the long-term care facility less any allowable deductions. Unfortunately, the majority of nursing home residents enter a facility without having done any planning which forces them to private pay until they are destitute. In this way, many spend themselves into abject poverty even though, through appropriate planning, eligibility for Medicaid could have been obtained sooner and could have preserved their assets for a spouse at home or future generations.

Proper planning would consist of utilizing the 100 days of Medicare coverage coupled with Medicaid coverage, which can be obtained retroactively up to three months prior to submission of an application for benefits. As I always like to say, "Plan in Advance to give your loved ones a chance or procrastinate and leave it up to the state!" For more information, please visit my website: www.daviaulaw.com, e-mail me ([email protected]) or call me at (508) 797-3010.

Check out my estate planning blog too: http://worcesterestateplanning.blogspot.com/

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