Q: What Is Medicare?
A: Medicare is a government health insurance program for individuals over the age of 65. It’s important to know that
Medicare does pay for some nursing home care, but it is limited to medically necessary skilled nursing and will only cover
a period of up to 100 days.
In most situations Medicare is limited to 20 days, provided skilled care is required, and a doctor has to write a
prescription for that. The remaining 80-day component falls under a category of care called Medicare Part A. This is for
skilled care. If at any time during the 80 day period a patient fails to thrive or refuses to do the therapy, then that will
trigger an event where the patient will drop off of Medicare coverage and go to private pay.
The medical condition is now known as a long term care condition and Medicare does not pay for the type of illness or
disability lasting more than 90 days.
Q: What Is Medicaid?
A: On the surface, the chief difference between Medicare and Medicaid is this: Medicaid has very little homecare
benefit. It’s not to say that one doesn’t exist, but it is very limited and varies from state to state. One significant
difference between Medicare versus Medicaid is that Medicare is a federal program, a government option if you will,
that has zero state variance.
Medicaid on the other hand is funded 50 percent by the federal government and 50 percent by the individual states.
Administratively speaking Medicaid is 100 percent state-run. In a nutshell, Medicaid is a Federal program but controlled
locally. Because the Federal Government allows individual states to control things, this causes many variances from
state to state. Is there any wonder why this is a confusing a complex program?
Q: What is the Big Medicaid Myth?
A: Like most folklore and myths, someone, somehow, somewhere started a rumor that Medicaid is for poor broke
people. Nothing could be further from the actual truth. As a matter of fact, over 50% percent of people in nursing
homes are on Medicaid. Does that mean that 50% of people in a nursing home are poor? Hardly!
So in its purest form, Medicaid is the Long-Term Care avenue of payment for most people in middle-class America with
assets ranging from $100,000 to $1 million!
Q: What assets can Medicaid require to be spent down before a person becomes eligible?
A: Assets such as cash, bonds, savings, stocks, life insurance cash value, real property, etc. With proper planning and
competent advice, all of these assets can usually be preserved.
Q: Once you are in a nursing home, are there still planning options available?
A: Yes. It may be possible to protect many of your assets including your life savings and still be eligible for nursing
Q: If the Medicaid applicant has a spouse, are the spouse’s income and assets included?
A: The at-home spouse’s income is not considered in determining the applicant’s eligibility. However, all marital assets
are considered. Income and savings above typical allowable limits can be protected if you know your legal rights.
Q: Why is nursing home planning so important?
A: The money saved from years of hard work can be depleted quickly when a family member requires long-term care.
The loss of lifetime savings can have a devastating financial and emotional impact on the entire family. With
competent advice it is often possible to preserve all of your life savings, your family home and investments and still
qualify for nursing home benefits.