This is the misunderstanding that costs American families the most money. Medicare is short-term medical insurance. Medicaid is long-term care insurance for people who've spent down their assets. They are not interchangeable.
| Medicare | Medicaid | |
|---|---|---|
| What it is | Federal health insurance for 65+ and certain disabilities | Joint federal-state program for low-income Americans |
| Who qualifies | Almost everyone at 65 | You, after spending down assets |
| Pays for short-term skilled nursing? | Yes — up to 100 days after a qualifying hospital stay | Yes |
| Pays for long-term custodial nursing-home care? | No | Yes — biggest payer in the US |
| Asset limit to qualify | None | Typically $2,000-$3,000 for an individual |
| Look-back on past asset transfers | None | 5 years |
| Spousal impoverishment protection? | N/A | Yes — the well spouse keeps a portion |
| How to apply | Automatic at 65 if you've worked | Apply through state Medicaid agency |
| Average wait for approval | Immediate | 30-90 days, often longer |
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Get a real opinionYes — about 12 million Americans are dual-eligible. Special Medicare Advantage D-SNP plans coordinate both. Often the most appropriate setup for someone in long-term care.
Not without consequence. The 5-year look-back period scrutinizes any transfer. Talk to an elder-law attorney before transferring anything.
No. This is the most common misunderstanding in eldercare. Medicare pays for short, skilled, recovery-oriented care. Long-term custodial care — bathing, feeding, supervising — is not covered.