Who Pays for What?

Everyone knows eldercare is expensive. But what does Medicare or Medicaid cover and how much does your loved one or you have to pay out of pocket? How much does it all actually cost? Here’s our attempt at a simple explanation.

First off, there are two basic types of costs: Medical Costs and Long Term Care Costs. Medical Costs are for things like visiting the doctor, stays in the hospital, emergency room visits, and prescription drugs. Long Term Care Costs are for basically everything else: things like help with meals, housework, and bathing, or the costs of living in an assisted living facility or nursing home.

For most people 65 or over, Medicare only covers Medical Costs. Long Term Care Costs have to be paid out of pocket.

The main exceptions to this rule are as follows:
- Medicare will cover a very limited amount of Long Term Care Costs during the recovery from a medical incident, like a hip surgery or heart attack
- Medicaid can help pay for Long Term Care Costs for people with low incomes who qualify
- The Veterans Administration covers some Long Term Care Costs for qualifying veterans

Also, Medicare does not cover the following costs unless your loved one has a Medicare Advantage plan (we’ll review Medicare vs Medicare Advantage later):
- Hearing Aids
- Dental Care
- Eyeglasses and Vision Care

Lastly, Medicare rarely covers 100% of anything. Your loved one is responsible for paying co-pays, co-insurance and deductibles unless they're also has Medicaid coverage.

To summarize, most seniors have to pay for the following:
- Medicare premiums. Usually Part A is free, but everything else has a monthly premium
- Medicare co-pays, co-insurance and deductibles
- Hearing Aids, Eyeglasses, and Dental Care if not covered by a Medicare Advantage program or other private insurance
- Ongoing home care like meals, housework, bathing assistance, and medication assistance
- Community Homes or Assisted Living Facilities
- Nursing Homes