Thursday, July 5, 2012

Medicare & Medicaid

I talk to many people every week about long term care and where it fits into Medicare and Medicaid. These terms can be confusing. Both are government programs and they sound a lot alike. It was probably not the best idea to name them so similarly, but what is done is done. I will help try and shed some light on the roles of each program in a quick and easy post.

Medicare was started in 1965 by the Federal Government to help US citizens or permanent residents over the age of 65 pay for the medical costs. Medicare is funded entirely by the Federal Government. If you or your spouse have been paying into Medicare for 10 years or more then you are eligible for Medicare at age 65. The idea of Medicare, a social insurance, is to spread the risk of medical costs across a society that is paying in. Medicare does not cover long term medical care needs, it is designed to cover restorative care or care that heals only. Long term care is care that helps you maintain your every day needs or activities of daily living. We have six activities of daily living: eating, dressing, bathing, toileting, continence (other bathroom needs like shaving and nail clipping) and transfer (movement). Medicare is not designed to cover these costs.

Medicaid is also a social program that helps those US citizens and residents cover their medical needs. However, Medicaid is a means tested social program. This basically signifies that your income and assets need to be at certain levels (usually current poverty line or below) to qualify for the aid. Medicaid can cover children of low income parents and the disabled as well. Medicaid is jointly funded by the Federal and State Governments and managed by the individual states. Medicaid is designed to be social protection and covers more health care services than Medicare. Medicaid will cover long term care needs in the facilities and with providers that they have approved.

So next time you get a little confused on the difference between Medicare and Medicaid and its role with long term care, come back to this post, I hope it helps clear up the confusion. If you have any further questions regarding Medicare and Medicaid feel free to contact me . (Especially, if you have any questions on Medicaid in NC, my resident state.)

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