One of the most common things that people tend to confuse is Medicare and Medicaid. These are very different government programs despite the similar name! Understanding the differences is an important step in leveraging these resources for one’s own benefit or those of a spouse, parent or family member.
Medicaid is a joint Federal, State and county entitlement program that covers long term care and home care. It is means tested in that it is an entitlement based on financial and medical eligibility. It is for people with chronic or disabling condition which requires either nursing care or constant supervision. The care is provided either in a nursing home or other setting such as the home. It covers home health care, personal care, adult day care, long term home health care, respite care, hospice care and help with ADL’s or Activities of Daily Living such as eating, bathing, dressing, toileting and ambulating. It covers custodial care as opposed to restorative care that is covered by Medicare.
Medicare, on the other hand, does not pay for most long-term care services. It is health insurance coverage and generally covers medically necessary services to treat illnesses or conditions such as doctor’s office visits, lab work, x-rays, and outpatient surgeries, and preventative services. It is an entitlement program that is based on work history, family relationship, disability and age. There are no asset and income limitations to qualify for Medicare. There is no coverage for custodial care when that is the only type of care required.
Despite the above, there is some Home Health Care Coverage (HHC) under Medicare, but it is limited. There are conditions for Medicare to cover some home health care coverage. The skilled health care must be needed to treat an illness or injury. Unlike Medicare coverage in a nursing home, there is no qualifying hospital stay required. The care needed includes intermittent skilled nursing care, physical therapy or speech and language therapy. One must be confined to home to qualify and be under the care of a physician who determines that Home Health Care is needed. Also, the Home Health Agency must participate in Medicaid. If all conditions are met, Medicare will pay for all covered services as long as they are reasonable and medically necessary. But it will not cover full time nursing care, meals delivered to the home or personal care and housekeeping services.