Medicaid vs. Medicare: Who Pays for What

#660: Caring for an aging parent can morph into a second full-time job, and even the most financially savvy adults get blindsided. Bank accounts freeze, home sales stall, and family savings disappear faster than anyone expects.

In this episode, we dig into what really happens when you take over a parent’s financial life, from the first power of attorney to the final tax return.

We explore the emotional and logistical realities of dementia care, Medicaid, trusts, probate, and why a single smartphone setting can determine whether you can access the information you need.

Veteran financial journalist and certified financial planner Beth Pinsker joins us to share the hard lessons she learned while managing her parents’ money, housing, and estate. She opens up about the “you don’t know what you don’t know” moments that hit even experts.

We look at why almost every caregiver reaches a breaking point, the two documents that can save a year of stress and tens of thousands of dollars, how a forgotten zero-balance home equity line nearly torpedoed a real estate deal, and why phone access now belongs at the center of estate planning.

We also confront the brutal math of long-term dementia care, the real differences between Medicare and Medicaid, how to evaluate facilities beyond brochures, and what happens when a parent dies without updated paperwork. Through it all, we focus on how clear conversations about wishes and values can reduce guilt and burnout for the people left steering the ship.

Key Takeaways

• Financial caregiving comes for almost everyone eventually, and even experts hit roadblocks, so the goal is not perfection but reducing avoidable chaos.
• Power of attorney and healthcare proxy documents are foundational, often more urgent than a will, and they need to be current, state-appropriate, and shared with the people who may need to use them.
• A locked smartphone without a legacy contact can become a financial brick, cutting caregivers off from essential clues about accounts, subscriptions, and bills.
• Long-term dementia care can run five to six figures per year, outlasting even solid nest eggs, so families need to confront the realities of Medicaid and state-specific safety nets before the money runs out.
• How assets are titled, from bank accounts to real estate, determines whether heirs inherit smoothly through a trust or spend years and thousands of dollars navigating probate.
• The most important “plan” is knowing a loved one’s wishes for quality of life and end-of-life care, so financial and medical decisions feel like honoring them instead of guessing in the dark.

Key moments

(0:00) Why financial caregiving blindsides even the experts

(05:18) The hidden home equity line that almost killed a real estate deal

(10:54) Two documents every adult in your life should have

(14:29) The critical phone setting that protects access to accounts and memories

(21:23) What Prince’s estate taught us about wills and inertia

(31:39) Planning for a decade of dementia care without going broke

(35:16) How Medicaid really works and why “running out of money” is a process

(38:46) The menu of care options from in-home help to CCRCs and nursing homes

(44:31) The “smell test” for evaluating facilities in the real world

(51:06) What to do in the first weeks after a parent dies

(54:38) Trusts, titles, probate, and how one frozen account cost $5,000 to unlock

(01:01:04) Knowing their wishes so money decisions feel like honoring, not guessing

Resources and Links

• Beth Pinsker’s website: bethpinsker.com
• Beth’s retirement and financial planning columns at MarketWatch
• Beth’s book, My Mother's Money, on financial caregiving and planning for aging parents and loved ones

Share this episode with a friend, colleagues, and anyone who is thinking about caregiving: https://affordanything.com/episode660

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