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Medicaid vs. Medicare

Posted July 03, 2013 in Advice Column, Urbandale

This is a common question I get when meeting with families who are considering their long-term care options.

Many families expect that Medicare will automatically cover a short- or long-term stay in a senior community. Oftentimes I find Medicare and Medicaid end up interchangeable among individuals discussing options with family members, when in fact, they are quite different. The easiest way to think of it is that MediCARE is your health insurance, where as MediCAID is your income or payer source.

Most of us have had health insurance throughout our life. Our Medicare is no different. This is the insurance individuals are entitled to through Social Security once they reach the age of 65. It ensures that our hospital stays, prescriptions, office visits to the doctor and so many more medical needs are either partially or fully covered so that we don’t end up paying for a hefty bill out of pocket and all on our own.

Medicare will only cover a short-term stay at a skilled nursing facility if you have had three admitted nights in a hospital. However, hospitals do have the option to leave an individual in what is called observation status, which is not considered a full admission to the hospital.  Sometimes this observation status can last several days. So it’s important to be aware of what your status is should you end up in the hospital. If you are admitted, your Medicare benefits will cover a stay in a skilled nursing facility for you up to 20 days, and those with a supplemental insurance (like Blue Cross or United Health Care) may have an additional 80 days of 100 percent percent coverage for rehabilitation.

Medicaid, on the other hand, is your income, so to speak. We all work hard our entire lives saving to be able to afford whatever care we may need as seniors. However, medical needs are expensive, and many times we eventually run out of the funds to afford the appropriate care that a senior individual needs. This is where Medicaid comes into play. When your funding begins to disappear you can fill out an application to be approved for Medicaid. You may also hear it referred to as Title 19. Once approved, Medicaid will help cover the costs of your care need. In order to qualify for Medicaid/Title 19 approval, you need to have at or less than $2,000 in all assets.  This includes a car, house, pension, etc.

Even with a quick explanation of the two, the processes that surround both Medicare and Medicaid can be confusing, so it’s important to be open and honest with your health care professionals and be sure to explore all options.

Information provided by Courtney Tiernan, community liaison director, Urbandale Health Care Center, 4614 84th St., Urbandale, (515) 270-6838.

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