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CHAPTER 12

It’s important to remember that if you are married and your spouse is still living, the rules will vary.

When Medicaid patients need to enter nursing homes and other care facilities, do you think they are able to choose where they want to go? Not really. Nursing homes and other facilities give preference to private-pay patients and those with long-term care insurance. You may find that if you were to pay for your care with Medicaid, you could wind up in a facility very far away from your family, who would then be unable to visit you very often. This is obviously not the preferred choice.

Medicaid benefits cover a broad spectrum of services. They also, with a few exceptions, don’t require any type of copayment, deductibles, or coinsurance for those who are eligible. They provide comprehensive coverage for acute care, as well as substantial cover- age for long-term care. This includes extended, and unlimited, nurs- ing home stays and some home health care services.

In the case of Medicare, the benefits that apply, coverage of skilled nursing home care and home health care, are limited in the long-term care context. Medicare home health care coverage only applies to either part-time or intermittent care for housebound patients. These patients must be under a physician’s care who must certify the need for the care. Medicare nursing home coverage covers skilled nursing care or skilled rehabilitative care occurring after a medically necessary hospitalization for at least 3 consecutive days, admission to the nursing facility within 30 days after the hospitaliza- tion, and only if a physician certifies the need for skilled care. Medicare would then pay for the first 100 days in such a facility, while requiring a copayment for days 21 through 100. They will not, however, cover the cost of care for custodial care.

Medicare is better suited to provide benefits for acute medical conditions, rather than long-term care coverage. Should you need any type of long-term care, you should investigate if you would be eligible for any type of Medicare benefits.

Long-Term Care Insurance The third option for those thinking about long-term care is to purchase long-term care insurance. Like disability insurance, this insurance

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