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Nursing Home Stays – Medicare and Medicaid Facts and Resources

talkingMEDICARE; News to Use for Agents in the Senior Market

 

The most significant difference between Medicare and Medicaid when it comes to nursing home coverage is that Medicaid covers nursing home care, while Medicare, largely, does not.  Medicare Part A covers only up to 100 days of care in a “skilled nursing” facility per spell of illness. The care in the skilled nursing facility must follow a stay of at least three midnights in a hospital. And for days 21 through 100, you must pay a copayment of $170.50 a day (in 2019).

Medicaid is a joint federal and state government program that helps people with low income and assets. It covers long-term care services in nursing homes, and long-term care services provided at home, such as visiting nurses and assistance with personal care. Unlike Medicare, Medicaid does pay for custodial care in nursing homes and at home.

 

Medicaid

Applying for Medicaid: https://longtermcare.acl.gov/medicare-medicaid-more/medicaid/applying-for-medicaid.html

Links to view Medicaid qualifications: https://www.healthcare.gov/medicaid-chip/  |  https://www.medicaid.gov/medicaid/eligibility/medicaid-enrollees/index.html

What is Covered by Medicaid in Nursing Facilities: https://www.medicaid.gov/medicaid/ltss/institutional/nursing/index.html

 


“Commonly an individual will enter a Medicare SNF following a hospitalization that qualifies him or her for a limited period of SNF services. If nursing home services are still required after the period of SNF coverage, the individual may pay privately, and use any long-term care insurance they may have. If the individual exhausts assets and is eligible for Medicaid, and the nursing home is also a Medicaid certified nursing facility, the individual may continue to reside in the nursing home under the Medicaid NF benefit. If the nursing home is not Medicaid certified, he or she would have to transfer to a NF to be covered by the Medicaid NF benefit.” – Medicaid.gov


Medicare.gov Resources

Comparing Nursing Homes: https://www.medicare.gov/nursinghomecompare/search.html

Skilled Nursing Facility (SNF) Care Benefits: https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care

Skilled Nursing Facility Rights: https://www.medicare.gov/what-medicare-covers/what-part-a-covers/skilled-nursing-facility-rights

Situations that may impact your SNF coverage and costs: https://www.medicare.gov/what-medicare-covers/skilled-nursing-facility-snf-situations

Information for nursing home residents, family members, and care givers: https://www.medicare.gov/NursingHomeCompare/Resources/infoforresidents.html

 

Medicare Publications

Medicare Coverage of Skilled Nursing Facility Care (Publication #10153): https://www.medicare.gov/Pubs/pdf/10153.pdf?

Medicare & Skilled Nursing Facility Care Benefits Getting Started (Publication #11359): https://www.medicare.gov/Pubs/pdf/11359.pdf?

Your Guide to Choosing a Nursing Home or Other Long‑Term Services & Supports (Publication #02174): https://www.medicare.gov/Pubs/pdf/02174-Nursing-Home-Other-Long-Term-Services.pdf?

Skilled Nursing Facility (SNF) Checklist: https://www.medicare.gov/sites/default/files/2018-07/skilled-nursing-facility-checklist_0.pdf

 

Additional Resources

Long Term Care Ombudsman Program: https://ltcombudsman.org/

Longtermcare.gov on Medicare: https://longtermcare.acl.gov/medicare-medicaid-more/medicare.html

Longtermcare.gov Home Page: https://longtermcare.acl.gov/index.html

LTC Planning Information for Individuals Turning 65: https://longtermcare.acl.gov/pathfinder/65plus.html

 


 

“Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years.”

 


 

Source: https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html