Medicare Eldercare Programs

Medicare is government-run health insurance for individuals who are at least sixty-five years old. Some exceptions are allowed for individuals who are less than sixty-five years old but have disabilities or end-stage renal disease. Medicare programs provide medical and financial assistance to individuals who need nursing home, assisted living care, or community and home care.

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

• Program of All-Inclusive Care for the Elderly (PACE) is an optional Medicare and Medicaid program for the elderly that allows them to receive comprehensive medical and social services at adult day care or inpatient facilities rather than a nursing home. To qualify for this program, applicants are examined by doctors, nurses, social workers and other health care professionals to determine if they meet the minimum requirements for their state's nursing home care. Applicants must be at least 55 years old, live in a PACE service area, and be able to live independently in a community. PACE program includes Medicare and Medicaid benefits, social services, personal care, prescription drugs and other supportive services. PACE is funded by Medicare or Medicaid.

Social Managed Care Plan (SMCP)

• Individuals who need medical and social services but can live independently in their own homes or in a community setting can apply for the Social Managed Care Plan (SMCP). Some benefits that SMCP offer are care coordination, prescription drugs, adult day care, personal care services, and medical transportation. Social Managed Care Plan is available in only four states: Oregon, California, New York and Nevada. To be eligible for SMCP, applicants must be at least 65 years old, have Medicare Part A and Part B and have proof that they have a family or friends to support or assist them in their daily living. Applicants with end-stage renal disease do not qualify.

Community and Home Care

• Medicare and Medicaid may pay for some medical costs related to home care for individuals who may be ill but can independently live at home with the aid of family or friends. Some programs such as Meals on Wheels, adult daycare and shopper services provide additional assistance to individuals to enable them live in their own home. Medicare may pay for some medical costs for short term nursing home care until the individuals until they are able to live on their own.