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Key Differences Between Medicare and Medicaid Coverage for Nursing Home Care

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Burlington Medicaid lawyers can provide insight into Medicaid coverage for nursing home care. It is important to understand the differences between Medicaid and Medicare when it comes to the payment of nursing home costs. Nursing homes may be the most expensive type of care that you will need, with the cost of a semi-private room in a nursing home totaling several thousand dollars per month.  Medicare and Medicaid have very different rules for covering these costs, so you need to make sure you understand exactly what type of coverage you will have — and make sure it is the coverage that you actually need. Waiting Room

Unsworth LaPlante, PLLC is here to help. Our legal team will work closely with you to ensure that you make smart choices about getting the types of coverage you require for your nursing home care or for your long-term care at home. Since the Wall Street Journal indicates that any person reaching the age of 65 has at least a 40 percent chance of requiring nursing home care, it’s important that you actually make these plans for your care.  Give us a call today to find out about the assistance that we can provide in helping you to get coverage.

How do Medicaid and Medicare Treat Nursing Home Care Differently?

Medicaid and Medicare have very different coverage rules regarding nursing home care. Medicare is much more restrictive in the circumstances when care will be covered. For example, Medicare will only provide you with coverage for any type of nursing home care or long-term care at home if the care is classified as skilled nursing care.  Skilled nursing care means that the care must be provided by an individual who has some type of medical training. A physical therapist, a registered nurse, or a speech pathologist are all examples of people who have specialized medical training and if you needed care from any of these individuals, then you could potentially be eligible to get that care covered by Medicare.

Medicare typically requires that you have a qualifying hospital stay in order for you to get care covered in the limited circumstances when you are eligible to have your care paid for. This means you must have crossed at least two midnights in the hospital.  The care must also be recommended by your treating physician. If all of these conditions are met, you can get the costs of a semi-private room and required services paid for in a skilled nursing facility through Medicare.  Medicare benefits are available to all eligible seniors who have enrolled for coverage. While those with higher incomes may face higher Medicare premiums, Medicare is not a means-tested program and you can still receive Medicare coverage even if you have substantial assets.

Medicaid, on the other hand, will cover nursing home care even in circumstances where you only need custodial care or routine help with activities of daily living. However, Medicaid is means-tested and if you have too many assets, you will not be able to get Medicaid to pay for your nursing home care — even if you would otherwise qualify to get this care cost covered.  Because Medicaid could be the only potential source of coverage for nursing home care, it can be important to make sure that you are able to get Medicaid benefits when you need them without having to impoverish yourself first by spending all of your money on the nursing home care you require.

Getting Help from Burlington Medicaid Lawyers

Burlington Medicaid lawyers at Unsworth LaPlante, PLLC will help you to make smart plans regarding getting your nursing home care covered. We can assist you with making your Medicaid plan no matter how old you are, what your personal situation is, and the nature and value of assets that you own. We can provide personalized guidance both in crisis planning when your need for nursing home care is imminent and you want to preserve as much wealth as possible, as well as in situations where you are planning ahead to keep assets safe.

To learn more about how our compassionate and knowledgeable legal team can provide assistance to you in making sure you are able to get covered for Medicare, join us for a free seminar. To find out more about the personalized help we can offer with making your Medicaid plan, give us a call at (802) 879-7133 or contact us online now.

Ellen LaPlante
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