Medicare and Medicaid are often lumped together but they are two very different programs designed to do different things.
Medicare is the over age 65 government sponsored health care program available to most seniors. It is designed to provide “rehabilitative” care either in a hospital (Part A) or outpatient setting (Part B). Medicare’s purpose is to bring a person back (or close to) his or her normal level of functioning after an incident or spell of illness. When, through age, illness or incident, a person cannot be rehabilitated above a certain level but still needs assistance to survive, that necessary assistance is called “custodial care.” Medicare, designed for rehabilitative care, does not cover custodial care.
Medicaid (administered by MassHealth in Massachusetts) is a financially need based government sponsored program that will pay for custodial care (such as is generally given in nursing homes) but a person must have very limited resources to be eligible for it. If a person’s assets are above these restricted limits, then paying privately or having long term care insurance (nursing home insurance) are other options for covering the cost of custodial care. Good pre-planning or emergency planning can help take the sting out of the cost of custodial care if you or somebody you love is facing a custodial care nursing home situation.
Roger Levine is a Massachusetts Estate Planning, Probate & Elder Law Attorney with offices in Canton & Brockton.