In this section: Distinguishing Medicare from Medicaid. Describes when each program will pay for the nursing home. Delineating the differences between the two programs. Medicaid vs. Medicare Let's get one thing straight first. Medicaid is NOT Medicare. MedicAID differs significantly from MediCARE. Because of the similarity of the spelling most people confuse the two programs. Most of us are fairly familiar with the Medicare program. We either have used it to pay for hospital and doctor visits, or our parents have. Regardless, everyone has seen the deduction on their paycheck. Medicare, briefly, is a type of public health insurance that pays for primary care including doctors visits. Every senior who has paid into the Medicare system during their working years is eligible for Medicare. There are two "parts" to Medicare Part A and a Part B. The "A" part pays for hospital visits while the "B" part picks up part of your outpatient doctor visits and some other medically related services. It will, and this is one place where the confusion begins, even pay for nursing home care. The catch is, it will only pay for nursing home care under some very limited circumstances, and even then for no more the 100 days. On the other hand many of us have never encountered the Medicaid program. Medicaid is a needs based program. Its eligibility requirements are based on the perceived need for assistance based upon an inquiry into the individual's financial and medical position. This is the starting point for determining eligibility for benefits which is broken down into two avenues of inquiry, a medical need and a financial need. The catch here„you must meet the eligibility requirements. Throughout this booklet you will see me break things down into two part, three part and four part "tests". These tests are nothing more than thresholds which must be crossed before the Medicaid program steps in and helps. These "tests" are more fully detailed in the section to follow entitled "Eligibility Requirements." Nursing home care is an extension to our overall medical treatment system. Hospitals, physicians, therapists, and nursing homes form a web of care that is part of our societies answer to maintaining our health. Medicaid pays for this long term nursing home care. It comes to Medicare's rescue by filling a gap left open by the Medicare system, and will pay indefinite without Some have argued that instead of fiddling with the eligibility requirements of Medicaid, Congress could have just added a Part "C" instead of expanding the Medicaid program. Here is a summary of the two programs: MEDICARE Health Insurance for seniors. Need to have contributed to Medicare system to be eligible. Pays for primary hospital care and related medically necessary services. Generally individual must be over 65 to be eligible. May have a co-pay provision depending on the services received. Federally controlled, uniform application across the country. MEDICAID Needs based health program. Pays for long term care. Individual must meet income and asset test to be eligible. Individual must be over 65, disabled or blind. Requires mandatory contribution of ALL recipient's income. Individual state by state differences create a different program in each state. (Generally similar, but may be different in specific application.) Even though the Medicaid program seemingly has strict financial requirements, there are options with which a family can restructure its assets to qualify for benefits while preserving at a large part of the assets for the remaining family members and or the person in the nursing home. See the section on planning strategies to get an idea of some of the options.

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