When it comes to paying for care, families are often confused about which program pays for what services. Both Medicare and Medicaid may cover different aspects of a single person’s care, and it’s important to understand the role of each program.

 What is Medicare?

Medicare is health insurance for people 65 or older, certain people with disabilities under 65, and any person with End-Stage Renal Disease. Medicare provides: hospital insurance (part A), medical insurance (part B), and prescription drug coverage (part D). Medicare recipients can have either traditional Medicare and a supplement, or they can participate in a Medicare Advantage plan (Part C), which is administered through a Medicare-approved private insurance company that provides all of the Part A, Part B, and Part D services for one cost. The choice of which type you want is a complicated one that can have long-lasting effects. The primary thing to remember about Medicare is that it is limited in terms of what long-term care it will pay for. Medicare only pays for skilled nursing care, otherwise known as rehab. When you stop progressing in rehab and then need long-term care, Medicare stops paying. Medicaid then becomes your option.

What is Medicaid?

Medicaid is a program funded by the Federal and State governments that pays for medical costs for certain low-income families and persons needing long-term care. In Tennessee, this program is called TennCare, and the branch of TennCare that pays for long-term care is called CHOICES. CHOICES pays for care in nursing homes, assisted living facilities, and private residences. The specifics of each program are slightly different, but eligibility for all is the same: there must be evidence to show that the person needs a nursing home level of care, and they must qualify financially.

What happens if you have both Medicaid and Medicare? 

If you have both Medicare and Medicaid, you are in a unique status called “Dual Eligible.” This means that Medicare and Medicaid cost share your medical expenses so that out-of-pocket costs should be minimal for you. Medicare is still the primary insurance, but Medicaid will cover things that Medicare does not cover at all or only covers partially.

For help assessing your Medicare and Medicaid eligibility and making important decisions about which types of Medicare to claim, talk with a qualified attorney who is familiar with both programs.  They can advise you about the long-term consequences of your decisions and help you to choose the plans that will best meet your needs, avoiding missteps along the way.  Wise decisions up front can represent huge savings for yourself and your family over time and help you steer clear of a care crisis.

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