Many mistakenly believe that government programs provide sufficient coverage for long term care. However, this is not the case.
Generally Medicare does not pay for long term care.
Medicare pays only only for medically necessary skilled nursing facility or home health care. You must meet certain conditions for Medicare to pay for these types of care. However, most long term care services do not meet the narrow definition of what is covered by Medicare.
Most long term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn't pay for this type of care called "custodial care". Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring.
Medicaid is a State and Federal Government program that pays for certain health services and nursing home care for older people with low incomes and limited assets. For those with limited assets and who cannot afford the cost of private insurance, Medicaid may be the only choice.
In most states, Medicaid also pays for some long term care services at home and in the community.
Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources.
Often you must spend down your personal resources (assets) before you qualify for Medicaid. You may want to get more detailed information from your state Medicaid office or an attorney before spending down your resources. Some people think that giving their resources to a family member or friend will make them eligible for Medicaid. There are certain rules for spending down your resources. States are required to find out if any resources were given away before you get Medicaid. If a state finds that resources were given away, the state must charge you a penalty. For example, this penalty may be to stop paying for your nursing home care.
Coverage is limited to Medicaid licensed facilities with an available Medicaid beds. Because of this, you may have no or limited choices about where care is provided or by whom.
The quality of care provided to Medicaid patients approved facilities may not be as high as that provided to private pay patients.
The amount received from Medicaid may not be sufficient to pay all your long term care costs.
