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Major Elder Law Issue: Medicaid v. Medicare

On Behalf of | Apr 24, 2014 | Elder Law

Elder Law issue:  Medicare vs. Medicaid: What is the difference?

A common issue is Elder Law is medical coverage.  Understandably, the difference between Medicare and Medicaid is confusing. The names are remarkably similar, they’re both government funded and run healthcare related programs and many people 65 and older utilize them. So what is the difference? And why should it even matter?

Medicare is a health insurance program, run by the federal government, for individuals aged sixty-five and older. You have likely heard about the various parts of Medicare. Part A covers hospital care, Part B covers general medical care, such as outpatient treatment, office visits, and some medical supplies and Part D covers prescriptions. Medicare Part C includes Medicare “advantage plans”, which are offered by private insurers to give Medicare recipients more comprehensive health coverage.

Many individuals aged sixty-five and older require long-term skilled nursing care. While Medicare does cover some rehabilitative nursing care, the coverage is for a limited period of time. What happens when someone needs to be moved to a facility for skilled nursing care indefinitely? When the average cost of skilled nursing home care in Pennsylvania is approximately $8,800.00 per month, it is difficult to imagine that many people can afford to pay such an astronomical amount. Medicaid is the answer to this question of paying for long-term care.

Medicaid, which, in Pennsylvania, is known as Medical Assistance or “MA”, is a federal and state funded social welfare program, which provides health care coverage for individuals who do not have the means to provide for themselves. As with all social welfare programs, there are certain requirements [link to blog on MA eligibility] that an individual must meet in order to qualify. Each state sets its own eligibility requirements. For those who meet them, Medicaid can pay for long-term skilled nursing care, alleviating a substantial financial burden.

Recently, the Affordable Care Act (also known as “Obamacare”) expanded Medicaid long-term care coverage to individuals aged nineteen and up who require long term care. However, as I mentioned, Pennsylvania sets its own rules. As of January 2014, Pennsylvania has not decided whether to expand Medicaid under the Affordable Care Act, or to maintain its current restriction, denying coverage for individuals younger than age sixty-five.

Do you have concerns about paying for your long-term care? Do you have a parent or spouse who has been or is about to be admitted to a skilled nursing facility? Call our office at 724-940-0100 to speak with a Pennsylvania Elder Law Attorney who can guide you through your options.