Mystery Solved: Medicaid, Medicare and Long-term Care

Mystery Solved: Medicaid, Medicare and Long-term Care

Posted on November 21, 2014 by ElderCare Resources in Blog, Caregiver Education, Government Agencies, Medicare / Medicaid, Nursing Homes

Medicaid vs. Medicare when it comes to long-term care

By: Shawn Garner

Living life with a disability can often be tough. But if you or a loved one is afflicted with a disability, you should become familiar with the benefits available so you don’t have to fight a losing battle to make ends meet. The government provides aid to those with disabilities in various ways. One form of “need-based” assistance is Medicaid.

Related: Medicare, Medicaid & Long-Term Care

Medicaid is designed to help pay for hospitalization, outpatient services, physician’s services, nursing home care and home health care for medically needy individuals who are unable to pay for the services on their own. In Arizona, Arizona Long-Term Care System (ALTCS) is the administrative agency that determines what Medicaid benefits are made available. Candidates for these benefits include residents who are 65 or older, blind, or disabled and need ongoing services at a nursing facility level of care. However, program participants do not have to reside in a nursing home. Many ALTCS participants live in their own homes or an assisted living facility and receive needed in-home services.

The applicant must meet three basic criteria to qualify for ALTCS benefits: They must be medically eligible, income eligible and meet the resource limit.

Related: Understanding The Differences Between Medicaid and Medicare

There is a common misconception that Medicare (not Medicaid) covers the costs of long-term care. Although Medicare will help pay for a short stay in a skilled nursing facility, certain conditions must be met. Even if you meet all the conditions required, Medicare will pay a majority of the cost for the first 20 days. Between days 21-100, you are responsible for approximately 80 percent of your daily expenses. After day 100, you or your family are responsible for 100 percent of the nursing facility’s bill.

Since there are many exceptions as to what sources of income and which types of resources are “counted” in determining eligibility, it is important to speak with a professional that is familiar with ALTCS prior to applying. Applying without professional assistance may result in your application being denied before you have a fair opportunity to be considered for benefits that are available.

Related: More Than Words. Elder Care Medical Lingo & Their Meaning

Shawn Garner is a Yuma attorney with Deason Garner Law Firm who focuses in the practice area of elder law. The firm is a member of the American Academy of Estate Planning Attorneys.

Published: Yuma Sun