One of the most common and costly misunderstandings among Ohio families is the belief that Medicare will pay for a loved one’s long-term nursing home care. It usually does not. Understanding the difference between Medicare and Medicaid is essential for any family facing long-term care decisions.
What Medicare Covers
Medicare is federal health insurance available to individuals age 65 and older (and some younger individuals with disabilities). It covers hospital stays, doctor visits, prescription drugs, and certain short-term skilled nursing care.
Medicare may cover up to 100 days of skilled nursing facility care, but only after a qualifying hospital stay of at least three consecutive days, and only if the patient needs skilled care (such as physical therapy or wound care) on a daily basis. For the first 20 days, Medicare covers the full cost. For days 21 through 100, the patient pays a daily copayment ($217 per day in 2026).
After 100 days, Medicare coverage ends entirely. And most critically, Medicare does not cover custodial care, the ongoing, non-medical assistance with daily activities like bathing, dressing, eating, and toileting that most nursing home residents need long-term.
What Medicaid Covers
Medicaid is a joint state and federal program based on financial need. In Ohio, Medicaid covers long-term custodial nursing home care for eligible individuals, with no time limit. Once qualified, Medicaid pays for the full cost of nursing home care for as long as the recipient needs it.
The catch is that Medicaid has strict income and asset requirements. In Ohio in 2026, a single applicant must have income below $2,982 per month and countable assets of $2,000 or less.
The Gap That Catches Families Off Guard
The typical scenario plays out like this: a parent falls, breaks a hip, is hospitalized for several days, then moves to a skilled nursing facility. Medicare covers the first few weeks. The family assumes everything is being handled.
Then, around day 20 or 30, Medicare benefits start winding down. The nursing facility informs the family that the patient is no longer receiving “skilled” care and now needs “custodial” care. Suddenly, the family is responsible for the full cost, often $8,000 to $12,000 or more per month.
This is the point at which many families first learn about Medicaid and begin scrambling to apply. By then, valuable planning time has been lost.
Why Early Planning Matters
The families who are best prepared are those who begin Medicaid planning before a crisis occurs. Because Ohio Medicaid uses a five-year look-back period, strategies like asset protection and trust planning are most effective when implemented well in advance.
However, even families facing a crisis right now have options. The Toron Law Firm helps Cincinnati families navigate both Medicare transitions and Medicaid applications.
Call The Toron Law Firm at (513) 563-3007 for a free consultation.
