What is the difference between Medicare v. Medicaid? Can I have both?

One of the biggest things to consider when deciding on an assisted living facility is the cost. As a senior, you may be covered by Medicare and/or Medicaid, but what’s the difference? Can either help cover the cost of assisted living? 

What is the Difference between Medicare and Medicaid?

Medicare is a federal health insurance program for people 65 and older, covering things like emergency medical procedures, lab tests, checkups, and preventative care. Because it is a federal program, its benefits are the same regardless of which state you live in. In short, Medicare is health insurance for seniors.

On the other hand, Medicaid is a state-run program that provides financial aid to help cover medical expenses. To be eligible for Medicaid, you have to earn less than a certain amount of income. As a result, you can have both Medicare and Medicaid if you meet the income requirements and are 65 or older. While Medicaid is jointly funded by federal and state governments, each state’s program offers different benefits. 

Can Medicare or Medicaid Pay for my Assisted Living?

Medicare cannot cover the cost of assisted living. It does not cover long-term care costs, such as those of assisted living facilities or memory care—those count as living expenses rather than medical ones. Keep in mind that Medicare only covers strictly medical expenses, hence why it cannot cover the costs of a living community like an assisted living facility. 

Medicaid, on the other hand, may be able to cover some of the costs that come with an assisted living facility. When it comes to assisted living, Medicaid typically covers medical-related expenses, but not living expenses like room and board. However, every state differs in what is covered by Medicaid, so it is important to look into what your state’s Medicaid can cover in assisted living. There are some facilities in New York that allow Medicaid to cover certain medical costs that come with assisted living, but not living expenses like room and board.

The state has another option, however: New York offers the Assisted Living Program (ALP), which covers all of the costs of assisted living. To qualify, you must be eligible for and require nursing home levels of care. You must not, however, require constant nursing, be bedfast, or be so impaired that you would pose a danger to other residents. The ALP is open to both Medicaid recipients and private payers, but 85% of participants do receive Medicaid. There are, however, only a few facilities with ranging levels of care that can be covered by the program, so it is important to understand what your needs are before applying to the program. It is worth speaking with an Oasis Senior Advisor to see if you qualify for the ALP and if it can provide you with a suitable community.