Category: Senior Health

Difference Between Medicare and Medicaid and Medi-Cal


Anyone who begins looking into long-term care options will quickly run into the terms Medicare, Medicaid and Medi-Cal. Many people are confused but these are three different programs. In today’s post, Let’s do our best to give you a basic overview of the three different programs.

Let’s talk about the three M’s. The Medicare, Medicaid and Medi-Cal.

MedicareSo these terms are used a lot for seniors because they are the medical services that you receive once you reach age 65. But there is a ton of confusion around them. And unfortunately the names are so close to each other, that people often interchange them and use them alternately when their very different programs.

Let’s start with a few definitions to kind of clarify things for folks.

The first is, what is Medicare?

(Medicare) is probably the most common government benefit that seniors are able to take advantage of next to Social Security. What it is, is it’s the medical coverage for seniors over the age of 65. So, it covers doctor visits. It covers prescriptions. It covers hospital stays and to a certain extent it will cover some long term care or some skilled nursing stay if you’re rehabilitating from a surgery. But it is the most common and you often get it when you’re 65. That means you stop having to pay private health coverage premiums. And it’s the most common program out there. It is very different from Medicaid.

So, M-E-D-I-C-A-I-D.

Medicaid is a federal and state medical program for seniors that allows for payment if that person is age and disabled and they qualify, asset wise or financially, for this service. It’s a form of welfare. You apply for Medicaid at the wealth your local county welfare office. And it will provide for the majority of the costs of a stay in a skilled nursing facility. It also provides for in-home care for elderly if you qualify. For in-home caregivers to come in if you have a long term illness. And in some states it will cover assisted living – not in California.

The final M, Medi-Cal.

long-term careAnd that is California’s version of Medicaid. So again, it’s administered through the welfare department in your county. So that’s where you would apply. That’s you know, you would get assigned a social worker. And those are where the services would derive from. It is a different program in California as it’s different in every other state. In California the qualification requirements are different than any other state good example of that is PACE.

If You’re Googling Medicaid and Medi-Cal, you’re going to get some mixed information. So, the recommendation is if any of you need Medicaid or Medi-Cal, you should contact an experienced attorney who works in this area. Because, the rules and regulations are very complicated and it is risky to go it alone.

That is the difference between Medicare, Medicaid, Medi-Cal. This might have confused you even more, don’t know. But always, when push comes to shove and you need to get information.

Don’t google it, give a an experienced disability attorney call or visit.


Skilled Nursing Facilities

Skilled Nursing Facility

We don’t like to think about this level of retirement housing but it is always waiting in the wings. It may just mean that you need therapy and physical assistance after recovering from surgery or other medical problems before returning to your own home. It doesn’t have to be a negative experience, but it is important to make your wishes known to your family before the unexpected occurs.

A skilled nursing facility, or nursing home, provides care to those who need nursing care but do not need to be hospitalized. This kind of care may be needed after a major surgery, an accident or for step down care after leaving a hospital if you are too frail to go home.

Essential Element For Nursing Facilities

Nursing FacilitiesAn essential element to grasp regarding skilled nursing facilities is that levels of care can vary, even within the same facility, ranging from intensive round the clock nursing, to personal care with minimal assistance and without any active nursing care.

Hospital facilities, called extended care facilities, are located within the hospital itself and provide the next highest level of nursing care after being hospitalized for an acute episode of some kind. These facilities are expensive and are not meant for long term residence so the average stay is only one or two weeks.

For example st paul medical clinic, a non-hospital based medical clinic will also provide comprehensive nursing care and includes a multitude of other services. A Skilled Nursing facility can be for either short-term, post-hospitalization recovery, or long-term for a permanent impairment.

A Skilled Nursing facility is often a comprehensive health care center, which means as you get better you can move down to the next level (an intermediate care system).

Intermediate Care Facilities

Nursing Care For SeniorsAssisted Living Care Facilities are good for those who are unable to live independently, but do not require intensive nursing care. These places provide medical attention and assistance with eating, dressing and bathing. There is always a licensed nurse on duty for emergencies.

Medicare and private insurances will pay only up to their coverage limits. Care has to be prescribed specifically by a physician and the patient has to have been recently discharged from an acute care hospital.

The only way to determine if a nursing home is a good one is to visit it yourself. Speak with staff members and with the residents and keep your eyes open. Your first impression may be your most important screening tool, but visit at different times of the day and ask questions about everything. Ask for and read state inspection reports. If you are looking at long term care and perhaps Medicaid coverage you will want to make sure the facility meets the requirements. Multiple moves are very confusing to people who already have a lot of negative things going on in their lives. Just because you are old does not mean that you don’t have the right to be happy. Finding a nice place is important but don’t forget that it is equally important to select a facility that is close to where the rest of family resides. Nursing home staff members are warm and caring individuals but it is up to the family to provide true social interaction.