August is here, and we suddenly realize how short is our time to conclude the series we began in June. We trust that these recent installments related to Medicaid myths have been profitable for you, and hope that today’s offering continues to provide helpful content for understanding one of the more misunderstood federal benefit programs. Before we get into today’s myth, we did see one interesting news item related to the study of Alzheimer’s disease and dementia that we thought we would pass along; we tend to be skeptical of the headline when the media highlights a study’s findings, remembering that many of the results of these studies turn out not to be replicable by others and ultimately prove to be unfounded years later. Even so, there does seem to be growing evidence for a link between the modern American diet and the manifestation of dementia.
As for Medicaid myths, today we actually want to remove confusion and provide clarity about another federal program: Medicare. By extension, this will help clarify Medicaid too, we promise.
As similarly named and related federal programs, Medicare and Medicaid are often confused. And for another excellent reason: fundamentally each program offers a payment source for various medical expenses—hospitalization, doctor’s visits, and payment for prescriptions. But there is one glaring coverage gap between what Medicare pays for and what Medicaid pays for, and that gap is long term care. This confuses many because Medicare does pay for care costs that look and feel just like long term care costs when those care costs are directly associated with recovery or rehabilitation from an illness or injury. Thus when someone is discharged from the hospital to a nursing home, Medicare typically does pay the bill for those over 65, at least initially. But Medicare won’t pay the bill once the patient has stopped pursuing the therapies and treatment plan options needed for further recovery, or after the individual has resided in the nursing home for 100 days. Once the sooner of those two thresholds is reached, Medicare stops paying the bill. At that point, the person must either pay for the cost of that care out of pocket (usually $300-$450/day), have long term care insurance to cover the cost, or qualify for Medicaid to get the bill paid.
The bottom line is that Medicare does not pay for long term care—only Medicaid does that. And unlike Medicare, being over 65 is not sufficient to ensure that Medicaid can be used as a payment source. Additional requirements must be met. Please don’t let your clients learn the hard way that this Medicare myth is just as false as any of the Medicaid myths we’ve covered this summer. The cost of that ignorance is too high.
This content is provided from The Senex, our bi-monthly e-newsletter for senior providers, written by Jeremy L. Pryor, Esq.
