Medicare is health insurance for:
Medicare covers medically necessary care only and focuses on medical acute care such as doctor visits, medicine and hospital stays. Medicare coverage also focuses on short-term services for conditions that are expected to improve, such as physical therapy to help a patient regain physical function after a fall or stroke.
However, Medicare’s skilled nursing facility (SNF) benefit does not cover most nursing home care. Medicare will pay the cost of some skilled care in an approved nursing home or in your own home, but only in specific situations. The SNF benefit applies only if a medical professional determines that you need daily skilled care after you’ve been in the hospital for at least three days and only in a nursing home that is a Medicare-Certified skilled nursing facility. Medicare may cover up to 100 days of skilled nursing home care per benefit period when these conditions are met. After 20 days, beneficiaries must pay a coinsurance fee. Beyond 101 days, it is considered long term care and the financial burden falls on you. Please note: Medicare does not cover the cost of care in assisted living facilities.
Do not rely on Medicare to pay for your long term care needs.
Medicaid is a joint federal and state government-funded program intended to help low income persons pay for some or all of their healthcare bills (doctor’s and hospital’s costs, nursing home or personal care.) Medicaid may cover nursing home costs, but many people won’t qualify due to incomes that exceed the levels set by their state of residence. Due to these regulations, many people end up paying out-of-pocket for nursing home care to “spend down” their assets and therefore be eligible for Medicaid.
Some assets and income can be protected for a spouse who remains at home. In addition, some of your assets may be protected if you have a long term care insurance that is Connecticut Partnership certified. Some assets, such as your home, may not factor when looking at eligibility. However, federal law requires Connecticut to recover (from your estate) the costs of the Medicaid-paid benefits you receive.
Contact the State of Connecticut Department of Social Services in Hartford for more information.
Phone: (203) 939-7765