What Is The Difference Between Medicare And Medicaid?
Without overcomplicating things, Medicare pays for acute injuries (things you can recover from). The Medicare system is designed to heal your injuries or health issues so you can return to your normal daily life. Medicaid, on the other hand, is a program that provides medical coverage for those in need and whose financial requirements must be met. Medicaid is also the primary payer for things you are not going to recover from, commonly referred to as long-term care or skilled nursing.
There is a lot of overlap and confusion when it comes to these two programs, so let’s look at a situation. Let’s say a mother falls, breaks her leg, goes to the hospital and gets admitted to the hospital for three overnights. You have to be admitted for three overnights for Medicare to kick in so that they can not only fix you up in the hospital but also pay for your rehabilitation. Medicare will pay for an acute injury as long as you’re recovering, and it will even pay for a skilled nursing stay – including the rehabilitation – while you are in a skilled nursing facility. Medicare will pay for the first 20 days completely and after day 20, there is a copay that varies up to day 100.
Is There A Catch?
Yes, here’s the catch: You have to continue to be getting better. The moment you stop improving or stop participating in rehab, Medicare often stops because the program will only pay to fix you up, not take care of you indefinitely. At the time you stop rehabbing or getting better, you become what we commonly refer to as private pay. Prior to the Medicare benefit being terminated, you will get a 48-hour notice that benefits will end.
It’s this time where most families start to experience a significant amount of stress because when Medicare stops paying for the nursing home, whether you’re able to go home or not, the bill becomes the family’s responsibility. The average cost of a nursing home is over $300 a day and is a daunting situation that can devastate many people’s finances. Please refer to our Medicaid section for some hope for your family.
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