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Learn the Facts 

Many families assume that Medicare and/or Medicaid will cover the costs of their loved one’s care. Unfortunately, that’s not entirely true, and there are several important issues to consider.

Mostly covering hospital and physician services, Medicare does offer some limited benefits for assisted living care and home healthcare.

Everyone Enrolled in Medicare is Entitled to the Same Basic Benefits, Including Coverage For:

• Medically necessary services to diagnose and treat illnesses
• Preventative care services and routine physical exams
• Medical equipment and devices that your physician has deemed necessary (including wheelchairs, prosthetics and oxygen)

Additional Considerations

Medicare only pays for long-term care if you require skilled services or rehabilitative care under specific circumstances. It’s important to keep in mind that it doesn’t pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services.

On the other hand, Medicaid is the single largest payer of long-term care expenses in the country. Many of those who fall below a certain income level rely exclusively on Medicaid to cover long-term care expenses.

Unlike Medicare’s highly restrictive conditions for payment of nursing home or home care benefits, Medicaid generally meets the need for long-term care for those who qualify. However, there are important limitations to consider.

The types of long-term care available to a Medicaid recipient are often limited. Benefits for home and community-based services are not offered everywhere, eligibility can be restrictive, and funding is typically limited. Those who rely on Medicaid to meet their long-term care needs often have limited choices of types of care and facilities.