Where Medicare stops
Medicare pays for medically needed hospital and doctor care, and for a limited time in a skilled nursing facility for rehabilitation after a qualifying hospital stay. It generally does not pay for long-term custodial care, which is help with daily activities like bathing, dressing and eating. Many families find this out only when they need it.
- Skilled care to recover after a hospital stay: limited coverage under Medicare.
- Ongoing help with daily activities for months or years: not covered by Medicare.
Where Medicaid steps in
Medicaid offers benefits not normally covered by Medicare, such as nursing home care and personal care services. Whether you qualify depends on your state's rules for income and resources and other requirements like residency. Some states let people 'spend down' the income above the state's limit by paying non-covered medical costs until they qualify.
- Rules differ in each state, so the same situation can have different answers in different places.
- Many states also offer care at home or in the community, so a nursing home is not the only option.
- Your state Medicaid office is the place to ask what applies to you.
Two things people are surprised by
Long-term care Medicaid has rules that go beyond income.
- Look-back: most states review financial gifts and transfers made in the five years before you apply, and a transfer can delay eligibility.
- Estate recovery: in many cases a state can seek repayment of certain long-term care costs from a person's estate after death. The rules vary, and some situations are protected.
Getting good advice
Long-term care planning is one area where a small mistake can be expensive. Free guidance is available through your State Health Insurance Assistance Program and your local Area Agency on Aging, and an elder law attorney can advise on your specific situation. This guide is general information, not legal or financial advice.