Medicaid and Medicare Road Signs

Two of the biggest fears the elderly have in this country are declining health and running out of money. Once you turn 65, of course, Medicare will kick in to cover most of your medical costs, easing some of the worry. However, while Medicare is an invaluable program for seniors, it does not cover all of the cost of a nursing home or assisted living facility. If you or your spouse is in need of long-term care, your options for paying for it are using your income and life savings or applying for Medicaid.

Gaps in Medicare Coverage

In certain situations, Medicare will pay for a limited amount of long-term care. If you meet all of the following criteria, Medicare will partially cover up to 100 days in a skilled nursing facility:

  • You were hospitalized for at least three days
  • Within 30 days of hospital release, you were admitted to a Medicare-certified nursing home
  • You require skilled nursing care, physical therapy, or other forms of skilled care

If you qualify, Medicare will pay 100 percent of your nursing home costs for the first 20 days, but you will be required to pay a daily fixed amount ($176 in 2020) for days 21 through 100 unless this cost is covered by a Medicare Supplemental Insurance policy. After the 100th day, Medicare will not cover any nursing home expenses.

Qualifying for Medicaid

As a need-based program, Medicaid will cover the cost of approved nursing homes for people who qualify. However, in order to qualify, your income must be less than $2,349 per month (in 2020), and your assets cannot exceed certain limitations. There are steps you can take as part of a comprehensive estate plan to ensure that you will meet the asset requirements when you need a nursing home, including creation of a Qualified Income Trust (aka “Miller Trust”).

Talk to our Medicaid Planning Elder Law Attorneys

Our experienced Elder Law attorneys will review options with you now so that you are prepared to cover the high cost of long-term care if you or your spouse needs it one day. With five offices throughout Northeast Texas and Southwest Arkansas, we are conveniently located for clients from Dallas to Little Rock. Contact us to talk about Medicare and Medicaid today!


Ben King
Ben King helps clients in TX and AR with estate planning, asset protection, probate, and medicaid planning.