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Medicare and Medicaid
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Understanding Medicare and Medicaid Understanding the differences between cost, ability to pay and sources of payment can be frustrating and exhausting.
Cost is the amount to be paid for the care received. This can and does vary based upon the availability of private payment, long term care insurances and Medicare or Medicaid eligibility. Ability to pay is the source of payment for the care services. This could be private payment, insurance or Medicare or Medicaid if the resident is eligible. Private Pay is the cost of care when the resident has the resources to cover the cost or has acquired the insurance to cover those costs. Medicare is the federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid. So what is the difference between Medicare and Medicaid and how do I know what can be expected? Medicare will help pay for skilled nursing or home health care if you meet certain conditions. Medicare generally doesn't pay for long-term care. Medicare also doesn’t pay for help with activities of daily living or other care that most people can do themselves. Some examples of activities of daily living include eating, bathing, dressing, and using the bathroom. By going to the Medicare.gov website section entitled Paying for Long-Term Care and using the Medical Eligibility tool, you can determine what may be available in your situation. Please note the other options that may apply when locating payment resources for long-term care, for instance veterans may have resources directed from the Veterans Administration. Check this Medicare.gov website for current information about these benefit sources. Medicaid: Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources. The best sources for that information are the state Medicaid office or an attorney. In some states, people with Medicaid may get coverage for things like nursing home care, home care, and outpatient prescription drugs that aren’t covered by Medicare. To find out what you may be eligible for in Oregon, we direct you to the Oregon Department of Human Services website. To help you find the DHS office nearest the Columbia Basin Care Facility, go to the Community Information pages for The Dalles. It is not uncommon to have a combination of private pay, insurances, Medicare and Medicaid benefits being utilized at different times to cover care costs as physical and financial situations change. |
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