Medicare vs Medicaid for Long-Term Care
Medicare and Medicaid sound similar but work very differently for senior care. Understanding the distinction helps families plan realistically and avoid costly surprises.
Medicare: What It Covers
Medicare is federal health insurance for people 65+ (and some younger people with disabilities). It's based on work history, not income.
What Medicare DOES cover:
- Short-term skilled nursing (up to 100 days after a qualifying hospital stay)
- Home health care (skilled nursing visits, therapy)
- Hospice care
- Medical equipment
What Medicare does NOT cover:
- Long-term nursing home care (custodial care)
- Assisted living
- Memory care communities
- Most in-home personal care (bathing, dressing)
The 100-day limit explained:
- Days 1-20: Fully covered
- Days 21-100: You pay ~$204/day copay (2024)
- After day 100: Medicare pays nothing
- Must show continued medical necessity to get all 100 days
Medicaid: What It Covers
Medicaid is a joint federal-state program for people with limited income and assets. Rules vary by state.
What Medicaid covers:
- Long-term nursing home care (indefinitely)
- Some assisted living (in states with waivers, including Washington)
- In-home personal care services
- Adult day programs
Who qualifies:
- Must meet income limits (varies by state)
- Must meet asset limits (typically $2,000 for individual)
- Home and one car usually exempt
- Spouse has higher asset allowances
Key Differences
| Factor | Medicare | Medicaid |
|---|---|---|
| Based on | Age/work history | Income/assets |
| Nursing home | Short-term only (100 days max) | Long-term |
| Assisted living | Not covered | May be covered (state dependent) |
| Application | Automatic at 65 | Must apply and qualify |
| Cost to you | Premiums + copays | Little to none |
Planning Considerations
- Don't assume Medicare will pay for long-term care — it won't
- Medicaid planning should start years before it's needed (asset transfer lookback is 5 years)
- Long-term care insurance fills the gap if you have it
- Consult an elder law attorney for Medicaid planning strategies
Washington State Specifics
Washington's Medicaid program (Apple Health) includes:
- COPES waiver for assisted living and in-home care
- Relatively generous eligibility compared to some states
- Coordination with the state's long-term care insurance program