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  • Writer's picturePam

Medicare Versus Medicaid And Can You Get Medicaid For Nursing Home Care Without A Medical Need?

There is a huge difference between Medicare and Medicaid. Understanding how they work long before you need them is crucial. Medicare is an insurance program. Medical bills are paid from trust funds which are funded by those who are now covered. It serves people over 65 usually, whatever their income; and serves younger disabled people. Patients pay part of the costs through deductibles for hospital fees and other charges. There can also be small monthly premiums required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the federal government. Medicare can be used in assisted living or nursing care for medical expenses such as doctor appointments and medical care. Medicaid is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines. Medicaid will pay for a nursing home, only when it is medically necessary. If you choose to move to an assisted living facility because you would like to have some custodial care then you would not qualify for Medicaid assistance because you do not need to live there for medical reasons. If your loved one lives in an assisted living facility (that is privately owned) and they run low on money, they would not be able to apply for Medicaid and stay there. Additionally they would have difficulty trying to move to a state-run facility if they have no medical need for one. Before Medicaid will pay for a nursing home, you must have a screening done by someone to determine your specific needs. If you are in a hospital, the hospital will arrange it for you. Medicaid uses the information in your screening to decide whether you need a nursing home or not. If you do, they will decide what kind of nursing home is best for you. In order for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of skilled nursing care that is only available in nursing or skilled living facility. This is important to consider as our parents are getting older and are possibly at the stage where more care is becoming a necessity. Many of us do not think about these things until it is too late. It gets very difficult to find a place to care for an elderly person who can't live alone if they do not medically need it. I strongly suggest that anyone with these concerns consult a financial planner, elder care lawyer or disability insurance specialist. Do not wait until the money is almost gone to plan.

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