Tip – There’s a lot of misinformation and misunderstandings about these two programs.
On July 30, 1965, President Lyndon B. Johnson signed the Medicare and Medicaid Act, also known as the Social Security Amendments of 1965, into law. It established Medicare, a health insurance program for the elderly, and Medicaid, a health insurance program for people with limited income.
Medicare is an entitlement program that pays for hospital, doctor, and prescription medication costs. Medicare covers skilled-nursing services, physical, vocational, and speech therapy, and hospice care whether provided in a facility or in the home. It will cover up to 100 days of rehabilitation following a hospital stay in a rehabilitation center. Medicare does not pay for personal care services or the cost of care in an assisted-living facility or a skilled-nursing facility beyond the 100 days. There is no repayment requirement for any services you receive from Medicare. To qualify for Medicare all you have to do is to turn 65 and apply for the program.
When the elderly need long-term care they apply to Medicaid. Medicaid is not an entitlement program, and you must prove eligibility to receive Medicaid benefits. For an individual to qualify for Medicaid, they must have liquid assets of less than $2,000, which does not include their home, a single vehicle, or a prepaid funeral policy. A Medicaid recipient who is single cannot have income over $2,567 a month. (as of May 2023). However, if their income does exceed that amount, they can set up and use a Miller Trust, and still qualify. Finally, they must meet certain healthcare needs as evaluated by a nurse who is working for the Department of Health and Welfare.
Medicaid will pay for limited personal care services in the home, or it will pay for long-term care in an assisted-living facility or skilled-nursing facility. If you apply and qualify for the Medicaid program, your monthly income is applied to the cost of your care at the facility, and then Medicaid will pay the unpaid balance. You are allowed to keep a small amount of your income for personal needs and to pay for prescription costs. The calculation for a married couple is more complicated.
Generally, the spouse who is not in the facility can keep the home, car, and half of the liquid assets to provide for their needs.
Unlike Medicare, the benefits paid to you for your care under the Medicaid program must be repaid from your estate when you pass. This program is known as Estate Recovery. Your personal representative must notify Estate Recovery of your passing, and then your estate will receive a claim against it for the money that was paid by Medicaid for your care. I often compare it to a student loan; once you graduate from school, you receive a letter from the government saying that you now must pay your student loan back.
It has been my experience that there is a lot of misunderstanding and misinformation about how these programs work. It makes sense to talk with an attorney who specializes in this area of the law to help you receive the benefits you need.
View our “Senior’s Guide to a Well-Planned Future” on our website! Packer Elder Care Law – with you for life!
Tom Packer is an Elder Law Attorney serving all Southeast Idaho. As part of his law practice, Tom offers Life Care Planning to deal with the challenges created by long-term illness, disability and incapacity. If you have a question about a Senior’s legal, financial or healthcare needs, please call us.