Medicare vs. Medicaid for Senior Care in Ohio: What Actually Gets Covered

Understanding Medicare vs. Medicaid for Ohio Seniors

One of the most confusing aspects of senior care is understanding what's covered by Medicare, Medicaid, or neither. Many families are shocked to learn that Medicare doesn't cover long-term care—but Medicaid does.

This guide breaks down both programs, what they cover in Ohio, and how to qualify.

Medicare: What It Does (and Doesn't) Cover

Medicare is federal health insurance for:

• Adults 65+ (most seniors automatically qualify)
• Younger people with certain disabilities
• People with End-Stage Renal Disease

What Medicare DOES Cover:

✅ Skilled Nursing Facility (SNF) Care — But Only Temporarily

• Up to 100 days after a 3-day hospital stay
• Days 1-20: Fully covered
• Days 21-100: $200/day copay (in 2025)
• Requires daily skilled nursing or therapy

✅ Home Health Care

• Part-time skilled nursing or therapy
• Must be ordered by doctor
• Must be "homebound"

✅ Hospice Care

• For terminally ill (6 months or less life expectancy)
• Pain management and comfort care

✅ Medical Care

• Doctor visits, hospital stays
• Medications (Part D)
• Therapy and rehabilitation

What Medicare DOES NOT Cover:

❌ Long-term assisted living ❌ Memory care ❌ Independent living ❌ Custodial care (help with bathing, dressing, eating) ❌ Long-term nursing home care (beyond 100 days)

Bottom Line: Medicare covers medical care and short-term rehabilitation. It does NOT cover long-term senior living or ongoing help with daily activities.

Medicaid: Ohio's Long-Term Care Solution

Medicaid is a joint federal-state program for low-income individuals. In Ohio, Medicaid DOES cover long-term care—but you must meet strict financial requirements.

What Ohio Medicaid Covers:

✅ Nursing Home Care

• Full coverage for room, board, and care
• No time limit
• Must meet medical necessity (need help with 2+ ADLs)

✅ Assisted Living (via PACE or Ohio Assisted Living Waiver)

• Room, board, and care services
• Limited availability
• Waitlist in some areas

✅ Home and Community-Based Services (HCBS)

• Personal care aide services
• Adult day care
• Home modifications
• Respite care for family caregivers

✅ Medical Care

• All Medicare Part A and Part B services
• Prescription drugs
• Transportation to medical appointments

Ohio Medicaid Eligibility: The Numbers

Income Limits (2025):

For nursing home Medicaid:

• Individual: $2,901/month maximum income
• Married (both applying): $5,802/month combined
• Higher income: Can still qualify using a Miller Trust (Qualified Income Trust)

Asset Limits (2025):

• Individual: $2,000 in countable assets
• Married (one applying): $2,000 for applicant, $154,140 for spouse at home

What Counts as Assets:

• Bank accounts, CDs, stocks, bonds
• Second homes, rental properties
• Vehicles (beyond one car)
• Life insurance (cash value over $1,500)

What DOESN'T Count:

• Primary home (if spouse lives there, or equity under ~$688,000)
• One vehicle
• Personal belongings, furniture
• Prepaid funeral plans (up to certain amounts)
• Retirement accounts (for spouse)

"Spend Down": Getting to Medicaid Eligibility

Many Cleveland families have too much money to qualify for Medicaid initially. The "spend down" process helps you become eligible legally.

Allowed Spend-Down Strategies:

✅ Pay off debts (mortgage, car loan, credit cards) ✅ Home repairs and modifications (wheelchair ramps, bathroom safety) ✅ Buy an irrevocable funeral plan ✅ Purchase medical equipment ✅ Pay for care (reduce assets by paying privately first) ✅ Give to spouse (spouse can keep up to $154,140)

Prohibited Actions:

❌ Gifting money to children (5-year look-back penalty) ❌ Transferring assets to hide them ❌ Selling assets below market value ❌ Large gifts or transfers (creates penalties)

The 5-Year Look-Back Rule: Medicaid reviews all financial transactions for 5 years before you apply. Any gifts or transfers can create penalty periods where you're ineligible.

Pro Tip: If you think you might need Medicaid in the future, consult an elder law attorney BEFORE making any large gifts or transfers.

Dual Eligible: Having Both Medicare and Medicaid

Many Ohio seniors have both programs (called "dual eligible"):

• Medicare: Covers medical care, doctor visits, hospital stays
• Medicaid: Covers long-term care, prescription copays, Medicare premiums

If you have both:

• Medicare pays first for medical services
• Medicaid covers the gaps (copays, deductibles)
• Medicaid also covers long-term nursing home or assisted living care

Ohio-Specific Programs and Resources

1. PASSPORT Program (Pre-Admission Screening Providing Options and Resources Today)

• Helps Ohio seniors avoid nursing homes by providing home care
• Medicaid-funded
• Provides: personal care, homemaker services, adult day care, home-delivered meals

To qualify:

• Age 60+
• Meet Medicaid financial criteria
• Need nursing home level of care
• Want to stay at home

2. Ohio Assisted Living Waiver

• Allows Medicaid to pay for assisted living (not just nursing homes)
• Limited to certain facilities that accept Medicaid
• Waitlist varies by region
• Cleveland area has more options than rural Ohio

3. PACE (Program of All-Inclusive Care for the Elderly)

Ohio PACE locations in Greater Cleveland:

• CareChoice PACE (Cuyahoga County)
• ElderHealth PACE (Summit County)

PACE provides:

• All medical care
• Adult day center services
• Home care
• Nursing home care if needed
• Prescription drugs
• Transportation

To qualify:

• Age 55+
• Live in PACE service area
• Certified to need nursing home level of care
• Able to live safely in community with PACE services

4. VA Aid and Attendance Benefit

For Ohio veterans and surviving spouses:

• Up to $2,295/month (2025) for a veteran
• Up to $1,488/month for a surviving spouse
• Can be used for assisted living or home care
• Separate from Medicaid (can have both)

How to Apply for Medicaid in Ohio

Step 1: Gather Documents

• Last 5 years of bank statements
• Asset documentation (property deeds, investment accounts)
• Income records (Social Security, pensions)
• Medical records proving need for care

Step 2: Apply

• Online: benefits.ohio.gov
• In person: County Department of Job and Family Services
• By phone: 1-844-640-6446

Step 3: Assessment

• PASSPORT agency will assess care needs
• Determines nursing home level of care
• Usually done in your home or hospital

Step 4: Approval

• Processing time: 30-60 days typically
• Medicaid can backdate up to 3 months

Cleveland-Area Resources for Medicaid Help

Free Counseling:

• Western Reserve Area Agency on Aging: 1-800-626-7277
• Area Agency on Aging 10B (Summit County): 1-800-201-3538

Elder Law Attorneys (consult for complex situations):

• Specialize in Medicaid planning
• Help with spend-down strategies
• Protect assets for spouses
• Navigate the application process

Hospital Social Workers:

• If your loved one is in Cleveland Clinic, University Hospitals, or other Cleveland hospitals
• Social workers can help with discharge planning and Medicaid applications

Common Medicaid Myths—Debunked

Myth: "Medicaid will take my house." Truth: Ohio doesn't take your home while you're alive or if your spouse lives there. After death, estate recovery may apply, but many exemptions exist.

Myth: "I make too much money for Medicaid." Truth: Income above the limit can be placed in a Miller Trust to qualify.

Myth: "I have to be completely broke." Truth: You can keep your home, one car, personal belongings, and $2,000 in assets. Your spouse can keep much more.

Myth: "All nursing homes take Medicaid." Truth: Most do, but some only accept Medicaid after 2+ years of private pay. Always ask before moving in.

Myth: "Medicaid planning is illegal." Truth: Legal planning with an elder law attorney is perfectly allowed—but gifting assets within the 5-year look-back can create penalties.

Timeline: When to Plan for Medicaid

5+ years before care is needed: Ideal time to gift assets or set up trusts (avoids look-back penalties)

2-3 years before care is needed: Still time for planning with an elder law attorney

1 year before or currently needing care: Focus on spend-down strategies and proper application

Emergency/hospital discharge: Apply immediately; Medicaid can backdate

Pro Tip: Don't wait for a crisis. Even if you think you'll never need Medicaid, planning ahead protects your options.

Get Help with Medicaid and Financing

We can help you:

• Understand which Cleveland communities accept Medicaid
• Connect you with elder law attorneys for Medicaid planning
• Explain what private pay period is required before Medicaid
• Find VA Aid and Attendance benefits if eligible
• Navigate the Ohio Medicaid application process

Our services are completely free—senior living communities compensate us, so families pay nothing for our help.

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Questions about paying for senior care in Cleveland? See our pricing guide or contact us for free consultation.