Medicare/Medicaid
There is much confusion about what Medicare and Medicaid pays for.
Medicare is a governmental program to help pay for temporary care, usually post-surgery. Medicare does not pay for assisted living or long term care. Medicare will only pay while someone is recuperating from an illness or surgery. Should someone not be recuperating, Medicare will stop paying. Typically, Medicare will pay 100% for the first 20 days for a semi-private room in a skilled nursing facility (SNF). This would include the room, meals, nursing services and medically necessary supplies. Days 21 through 100, you will be responsible for the co-payment of $200 per day. (2023). After the 100th day, Medicare will cease to pay. Should someone not show any signs of improvement at any point during the 100 days, Medicare will stop paying.
Medicaid is a program for low-income seniors and is regulated by each state. In Florida, it is regulated by the Agency for Health Care Administration. Medicaid is only for skilled nursing and not assisted living. Not all facilities accept Medicaid and the ones that do, frequently hold Medicaid beds for patients already residing at the facility. Medicaid covers 100% costs of skilled nursing care at Medicaid-certified skilled nursing facilities (semi-private room) for patients who meet the criteria.
In Florida, there a Medicaid Waiver program established to help pay for assisted living. Currently, this program pays approximately $1,800 per month for care-related charges (not room and board). The waiting time is running about two years. Somone would need to be paying privately and living at an assisted living facility to qualify. It is very important to note that not all assisted living facilities accept the Medicaid Waiver program.
- Please be aware there are companies that promise eligibility. Usually, they charge a flat-fee for this type of assistance. Be careful with unrealistic expectations and/or open-ended promises.
For more information, go to: Medicaid (myflorida.com)