How Does Coverage for Long-Term Senior Care Differ Between Medicare and Medicaid?

Last updated on: Friday, 5 May 2023

In terms of long-term senior care, one will usually not receive any coverage with a Medicare plan. Though some policies will cover short-term, or respite care, for individuals who need skilled nursing for a certain illness, longer stays are not covered. Medicaid on the other hand has what is called Institutional Medicaid. This covers certain individuals who need long-term care. Though this can be helpful, one’s options when receiving this type of care are very limited. When dealing with senior care specifically, assisted living does not fall into the umbrella of what is covered under Institutional Medicaid. So, in order to receive affordable care, many individuals give up their independence. This type of situation is common for those who are not completely dependent on others for help but need some assistance to improve their quality of life. An individual whose needs would be best cared for at an assisted living facility would need to forgo this option so they can receive affordable care under the coverage of Institutional Medicaid. That being said, some states are becoming more accommodating, and can issue Medicaid coverage for assisted living on a case by case basis. The reasoning for this comes down to cost. Assisted living cost roughly 50% less than a nursing home, so the state could save a substantial amount of money if it allows an individual to utilize assisted living facilities.

To get the best understanding of your options you have to look into the Medicaid policies for your state because every state is different. If your state does not allow the use of assisted living substitutions, then it might be best to look into the home health care options Medicaid provides. Doing so could prevent a transition into a level of care that isn’t necessary, and ensure you stay as independent as possible.