Long Term Care Insurance vs. Medicare and Medicaid
There is a general confusion among people regarding the availability of long term care coverage. Many people think that they can get certain coverage for long term care through Medicare or Medicaid. But this article points out that a complete coverage and that also for all long term care services through Medicare or Medicaid is impossible. Such coverage is only available if people purchase long term care insurance policy. This article deals with all these issues and points out some of the drawbacks of Medicare and Medicaid in comparison to long term care insurance, when it comes to availing coverage for long term care services. Ultimately after reading this article you will be able to formulate your own decision, that whether you want to go for Medicare/ Medicaid or wish to purchase a long term care insurance policy separately!
There are many people who think that if they have Medicare, they are not required to purchase a long term care insurance policy separately. This is because, as per them few of the long term care benefits are covered by Medicare only. Another thing is that, a long term care insurance policy is a bit tough to afford than the Medicare program. Many people do not have the required budget for buying long term care coverage but still they need to have long term care benefits. So what do they do in such a situation? If such a condition turns up they either go for purchasing Medicare or sit idle if they are already under Medicare and think that they will be able to get long term care benefits automatically, by remaining under Medicare.
It must be remembered that if you are thinking the same, then you are wrong. The justification of such a verdict can be made if you have a little bit knowledge about the coverage options of Medicare and Medicaid. So let's get to know about them:
Getting to Know about Medicare
Medicare is a popular form of health insurance program that covers many of the healthcare expenses of people and also offers some medical care benefits. A majority of the residents of the United States presume that if they subscribe to Medicare or MedSup programs, they will also get coverage for meeting long term care expenses (only for a few long term care services) in addition to getting other healthcare coverage. Although it is true to a little extent but it must be mentioned that the terms & "conditions apply" are tagged beside such coverage. This means that people may be able to get long term care coverage but only under tremendously restricted conditions, which a person will not be able to maintain generally. You may get coverage for those long term care services, which you may not require at all. So you will need to spend you own money for getting your required long term care services.
Few of the obligations and shortcomings of Medicare
Medicare requires that you have to stay in a hospital in any case for 3 days and 3 nights. Then only after that, you will be able to receive coverage for only a part of the expenses, for the care services provided to you in a skilled nursing home, till a time period of 100 days. Remember that Medicare follows these rules and relegations strictly. In case you stay in the hospital for 3 days and 2 nights and apply for Medicare coverage in a skilled nursing home, then you will yourself acknowledge that in what manner Medicare consider your case. You will not be able to get coverage at all under any reasons, if you do such things.
Some of the other drawbacks of Medicare
In case you are availing care that is announced as custodial and not expert medical care, then you will not get any coverage from Medicare for staying in the nursing home. Also, if you are receiving coverage for staying in a skilled nursing home then after the period of 100 days is over, you can stay assured that your rights of receiving further coverage from Medicare, for your skilled nursing home stay is also over. So after this you will need to pay money out of your own pocket for the days that follow after the 100th day, until which you have to stay in the nursing home.
Like this, you will be able to receive coverage from Medicare for the medically required home healthcare checkups, by skilled healthcare professionals like physicians, occupational/speech therapy specialists etc. But it must be kept in mind that if the care you receive is custodial, then Medicare will not provide you any coverage. However if you are able to prove that the care you are receiving is rehabilitative and you are on the process of getting well, then you may get coverage from Medicare.
However the problem remains that whatever case it is, Medicare stops offering coverage after 100 days is over. So now most of the people are left with no other option but to turn their attention towards Medicaid from day 101 in order to get some benefits.
Getting to Know about Medicaid (also known by the name of MediCal in the state of California)
Medicaid is also a health insurance program that is managed by the State and Federal government. It is a health care program for those who belongs to a poverty status and cannot afford to pay for their healthcare requirements. Contrasting to Medicare, the Medicaid policy sometimes offers coverage for both skilled nursing care and custodial care services. However the coverage is generally restricted to receiving care in a skilled nursing home facility and rather than custodial care in most of the circumstances.
Few of the obligations and shortcomings of Medicaid
In order to be eligible for getting Medicaid policy, a person must be running on a limited budget and should also have fewer amounts of financial resources. His/her status should be considered as poor enough to pay to pay for required healthcare expenses. The eligibility criteria of Medicaid are too convoluted and vary from state to the other. Medicaid requires that a person can be an owner of properties (that may include land, home, vehicle or any others) whose total cost should not be more than $2,000. The person should have earnings of $30 every month, in hand in order to suffice his/her personal requirements. If he/she is found to posses more money than this (like monthly pensions, social security benefits etc.) or more financial resources, properties, then the extra income/assets will be undertaken by the state, in order to offer coverage for the healthcare services provided to the person by Medicaid. Apart from this the state in which you reside in, may impose some extra rules and regulations that need to be clarified by you.
Medicaid allows the spouse of any person to remain under it's coverage along with the other family members. In this case they can have properties and financial resources that may cost up to a sum of $82,000 when added together. However, such rules differ from one state to the other. In addition to this they will also be allowed to maintain an earnings of $2,000 every month to suffice the personal expenses of the family.
Some of the other drawbacks of Medicaid
However while getting Medicaid coverage, people have to face a difficulty and this is regarded as a major drawback of Medicaid programs. It is that once you go for Medicaid, your chances of visiting or getting care via any facility is restricted. When you go to any skilled nursing home for getting care, you will see that only a few beds are reserved for Medicaid patients (the customers of Medicaid). These beds are available only if you have accepted Medicaid totally. Plus if any nursing home accepts Medicare customers to get admitted; then only you will be able to get admitted there. There is another truth about Medicaid which is not known by many of us. It is that Medicaid makes a payment which is only half of the cost that is incurred for a person's nursing home stay. So this program often keeps the nursing home staffs poorly paid or pay them less for the services provided to you. So this may deprive you of getting expert care from them.
Formulate your decision about long term care
Therefore, from the above discussion we see that Medicare offers coverage for a restricted period of time and also for only a few of the long term care services. On the other hand Medicaid has been seen to have certain drawbacks that may deprive you of getting care. Plus, it should be remembered that only people with substantial poverty status can only become eligible for Medicaid. So you may or may not become eligible for getting Medicaid, which leaves you in a position of uncertainty and nothing else. No matter whatever plan you choose (Medicare or Medicaid); one thing goes for sure that none of these plans provides you complete coverage for all long term care services. So although you subscribe to Medicare or Medicaid you may have to suffer when you will have the requirement for long term care.
So in such circumstances you have no other alternatives, but to decide that whether you want to pay for your long term care expenses (in case your financial status allows you to do that) or purchase a long term care insurance policy to get coverage for such expenses and lead a tension free life. The choice is absolutely yours!
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