When families in Edmonds, WA and across the Greater Seattle Area begin thinking about long-term care, understanding the difference between Medicare and Medicaid is essential. Both programs offer support for medical care, but when it comes to covering the extended costs of a nursing home or assisted living facility, the distinctions are critical—especially for those in the Puget Sound region hoping to preserve assets while securing quality care.
At Washington Elder Law, we specialize in helping Washington seniors and their families plan ahead, ensuring that they qualify for benefits while safeguarding their financial legacy.
Medicare vs. Medicaid: What’s the Difference?
While both programs provide medical coverage, their structure and eligibility are quite different:
- Medicare is a federal entitlement program. Anyone age 65 or older who qualifies for Social Security benefits is automatically eligible. It’s designed to help with general healthcare costs.
- Medicaid is a means-tested public assistance program. It supports those with limited income and assets and is jointly administered by the federal government and the state of Washington.
Understanding the distinction between these programs is key for effective elder law planning.
Administration and Coverage in Washington
Medicare is managed entirely at the federal level, while Medicaid programs are coordinated between the federal government and individual states. In Washington State, Medicaid plays a vital role in helping seniors receive extended care services that Medicare simply doesn’t cover.
States that participate in Medicaid—like Washington—must meet federal requirements to receive matching funds, but they also have the flexibility to set their own income and asset eligibility rules. That’s why working with a local elder law attorney who understands the intricacies of Washington’s Medicaid guidelines is so important.
What About Long-Term Care?
Here’s where the difference becomes more pronounced for families in the Puget Sound area.
- Medicare offers very limited long-term care coverage. It only pays for up to 100 days in a skilled nursing facility and only after a hospital stay of at least three days. Plus, a daily copayment kicks in after day 20—currently set at over $167 per day.
Because of the restrictive rules and high copays, very few people in Edmonds or Seattle receive Medicare coverage for the full 100 days. - Medicaid, on the other hand, does cover long-term nursing home care for individuals who meet the financial eligibility criteria. Whether it’s for a few months or many years, Medicaid will continue to provide coverage as long as you qualify. Not surprisingly, it has become the largest single payer of nursing home care in the U.S.
Do You Qualify for Medicaid in Washington?
If your income and assets fall below Washington’s Medicaid thresholds, you may already qualify. However, if you exceed those limits, early and careful planning becomes crucial. You cannot simply transfer your assets weeks before needing care; Medicaid enforces a strict five-year look-back period, and improper transfers during that time can result in penalties and delays.
This is where Brian G. Isaacson and our team at Washington Elder Law can help. As experienced elder law attorneys serving Edmonds and the Greater Seattle Area, we guide families through legal strategies that make them Medicaid-eligible while protecting what matters most.
The Bottom Line for Families in the Greater Seattle Area
Medicare may cover short-term rehabilitation after a hospital stay, but for most long-term care needs—such as permanent residence in a nursing facility—Medicaid is the only realistic option. With the cost of care skyrocketing in the Puget Sound region, proper planning can make all the difference.
Whether you’re planning for your own future or helping an aging parent, don’t wait until a crisis hits. Contact Washington Elder Law today to schedule a consultation. We’re here to help you plan, protect, and provide for generations to come.
