Why This Confusion Is So Common
Both programs start with “Medi,” both involve the government, and retirees often use both — so families assume they cover the same things. Add hospital discharge planners saying “Medicare will cover rehab” without clarifying what happens afterward, and misinformation spreads fast.
The fix is simple: Medicare = medical insurance. Medicaid = long-term care safety net.
Medicare: What It Covers
Medicare covers hospitals, doctors, short-term skilled nursing after a hospital stay, hospice, outpatient therapy, lab work, and durable medical equipment. It does NOT cover long-term custodial care — no adult family home fees, no assisted living rent.
Think of it like health insurance that follows the person wherever they live.
Medicare: What It Doesn't Cover
No residential room and board, no personal care assistance, no long-term caregiver support. Once the skilled component ends, Medicare stops paying. Expecting Medicare to cover an AFH bill only delays real planning.
Medicaid: What It Covers
Washington Medicaid (through DSHS HCS) pays for adult family homes, some assisted living services, in-home caregivers, and nursing homes for eligible residents. It also pays medical costs, prescription copays, and Medicare premiums for low-income seniors.
Eligibility is based on income, assets, and functional need. Once approved, Medicaid coordinates directly with the care home.
Medicaid: Eligibility in Washington
Financial limits: $2,742/month income and $2,000 in countable assets for an individual (2024). Functional requirement: nursing facility level of care as determined by the CARE assessment. Married couples have higher allowances.
If you're over the limits, plan a spend-down strategy instead of assuming you won't qualify.
How to Use Both Strategically
Most seniors use Medicare for medical expenses and Medicaid for long-term care once resources run low. They coexist nicely: Medicare keeps covering doctors and therapy inside the AFH, Medicaid pays the monthly care bill. If your parent has supplemental insurance, keep it active until Medicaid officially takes over premiums.
Start the Medicaid application before savings run out so you can transition seamlessly.
Frequently Asked Questions
Q: Can someone have Medicare Advantage and Medicaid? A: Yes. That's called “dual eligible.” Medicaid may even cover the Advantage plan premium.
Q: Does Medicare pay anything toward AFHs? A: No. It only covers medical care delivered there, not the housing or caregiving.
Q: What about Medicare's 100 rehab days? A: That's only for skilled nursing after a hospital stay and ends once therapy goals are met.
Q: How early should we apply for Medicaid? A: When savings will cover less than 6–9 more months of care.