Medicare and Medicaid are two separate government programs that cover very different things when it comes to nursing home care in Georgia. Confusing the two is one of the most common and costly mistakes Georgia families make when a parent needs long-term care.
What Medicare Covers for Nursing Home Care
Medicare is federal health insurance for people 65 and older. It was designed for acute medical care — hospital stays, surgeries, doctor visits — not for long-term custodial care.
Medicare will cover nursing home care only after a qualifying hospital inpatient stay of at least three consecutive days. Even then, coverage is time-limited and requires that you are receiving skilled nursing care (rehabilitation, wound care, IV medications — not just help with daily activities).
Here is how Medicare Part A nursing home coverage works:
- Days 1–20: Medicare pays 100% of the approved amount
- Days 21–100: You pay a daily copay (approximately $200/day in 2026); Medicare covers the rest
- After day 100: Medicare pays nothing
Medicare does not cover custodial care — meaning care that helps you with bathing, dressing, eating, and moving around when you are not expected to improve medically. That is the care most nursing home residents need long-term.
What Medicaid Covers for Nursing Home Care
Medicaid is a joint federal-state program for people with limited income and assets. In Georgia, Medicaid is the primary payer for long-term nursing home care for people who cannot afford to pay privately.
Once you meet Georgia Medicaid’s income and asset requirements, Medicaid covers the full cost of nursing home care with no time limit. You pay a small personal needs allowance each month (typically $65 in Georgia) and Medicaid covers everything else.
The problem: qualifying for Medicaid requires spending down your assets to near zero ($2,000 for a single person). Without prior planning, most families must spend their savings before Medicaid kicks in.
The Typical Path for Georgia Families
Here is the reality of how most nursing home stays are funded in Georgia:
- A health event requires hospitalization (hospital stay)
- After discharge, Medicare covers nursing home rehabilitation for up to 100 days
- When Medicare stops, the family pays privately — $8,000–$10,000+ per month
- Savings are depleted over months or years
- When assets reach the Medicaid limit, the family applies for Medicaid
- Medicaid covers the ongoing cost of care
Families who did no planning watch their savings disappear entirely at step 4. Families who planned ahead — with a Medicaid Asset Protection Trust or other legal strategies — may have protected significant assets before step 4 ever happens.
Long-Term Care Insurance: The Third Option
Long-term care insurance is a private policy that pays a daily or monthly benefit for nursing home or home care. It can bridge the gap that Medicare leaves and reduce or eliminate the spend-down.
However: long-term care insurance is expensive, many insurers have exited the market, and many older policies have limited benefits that do not cover the full cost of modern nursing home care. If you have a policy, review it carefully. If you do not, the window to buy affordable coverage closes around age 65.
Planning Ahead Matters
The difference between families who protect their assets and families who lose everything to nursing home costs is almost always planning done years earlier. A Medicaid Asset Protection Trust, spousal planning strategies, and other elder law tools can dramatically change the outcome.
The Hive Law helps Georgia families understand the difference between Medicare and Medicaid, and builds legal plans to protect assets from long-term care costs. If you have questions about your family’s exposure, start with a Family Protection Audit — a 60-minute session with Melissa Breyer.