Medicare or Medicaid? Understanding Long-Term Care Coverage in Ohio
Many families are surprised to learn that Medicare and Medicaid serve very different purposes—and that misunderstanding the difference can lead to serious financial consequences when long-term care is needed. Medicare is a federal health insurance program primarily for individuals age 65 and older and certain younger individuals with disabilities. It covers medical care such as hospital stays, physician services, short-term rehabilitation, and limited skilled nursing care following a qualifying hospital stay. Medicare does not cover long-term custodial care. In Ohio, Medicare coverage in a nursing facility is generally limited to short-term rehabilitation—up to 100 days—and only when strict medical criteria are met. Once rehabilitation ends, Medicare coverage stops.
Medicaid is the primary program that pays for long-term care in Ohio, including nursing home care, certain assisted living programs through waiver services, and in-home care. Because Medicaid is needs-based, eligibility depends on income, assets, and financial transfers made within the last five years, known as the Medicaid look-back period. As of 2026, an individual applying for Ohio Medicaid long-term care is generally limited to $2,000 in countable assets and monthly income of approximately $2,982 or less. For married couples, Ohio’s spousal impoverishment rules allow the healthy spouse to retain assets up to a Community Spouse Resource Allowance of approximately $162,660, as well as monthly income of up to $4,066 under the Minimum Monthly Maintenance Needs Allowance. These protections are critical but are often missed without proper planning.
A common and costly misconception is the belief that Medicare will cover nursing home care indefinitely. When Medicare coverage ends, families are often faced with private-pay nursing home costs in Ohio that can exceed $7,000 to $9,000 per month. Without advance planning, savings can be depleted quickly, forcing families into crisis decisions during an already emotional time.
Medicaid planning helps families navigate these rules legally and strategically. With proper planning, it may be possible to protect a healthy spouse, preserve a home, and maintain assets while still qualifying for care. Without planning, families are often required to spend down nearly everything before assistance becomes available. Proper Medicaid planning is will help you understand the rules and using them correctly to protect families and preserve dignity.
When should you call an elder law attorney? Ideally, planning begins before a crisis occurs, but help is still available even when care is needed immediately. You should consider speaking with an elder law attorney if you or a loved one are experiencing declining health, facing a new diagnosis, entering or already living in a nursing facility or assisted living, worried about paying for care, or concerned about protecting a spouse, home, or life savings. Early guidance often means more options, less stress, and greater peace of mind. Thoughtful planning is not just a financial decision—it is an act of care for the people you love.
