As loved ones begin to lose the ability to manage their daily care, finding a facility that can provide these services becomes a high priority. Most people in Georgia turn to one of two federal programs: Medicare or Medicaid. Medicare is intended to pay for most health care services for people over 65, and Medicaid is intended to provide medical care for people who do not have the necessary income or savings to pay for their own care.
Long-term care can be divided into two categories: custodial care and skilled medical care. Custodial care refers to activities of daily living, such as bathing, dressing, transferring from sitting or lying to standing. This type of care is frequently provided by people without medical training. Skilled care requires the provider to have obtained a certain level of medical training. Some providers of skilled care, such as nurses, are able to also provide both types of care.
In the past, Medicare did not pay for custodial care. However, recent announcements from Washington appear to indicate that Medicare Advantage plans will be able to provide both skilled and custodial care. Beginning in 2019, Medicare Advantage plans will be able to pay for some forms of custodial care that are known to improve the patient's general health.
Up to this point, the distinction between Medicare and Medicaid benefits is fairly straightforward, but as people age and their medical needs become more extensive, the availability of federal benefits is not so obvious. The rules for nursing home/Medicaid planning become more complex. Medicare Advantage plans will pay 100% of the cost of skilled nursing home care for 20 days and 80% of the cost for the next 80 days. Beyond 100 days, skilled nursing care is not covered.
Medicaid may pay for a significant amount of nursing home care for low-income and low-asset individuals, but not everyone qualifies for this coverage.