When it comes to paying for nursing home care, there are two main programs that can help cover the costs: Medicare and Medicaid. Medicare is a federal health insurance program for people aged 65 and older, while Medicaid is a joint federal-state program that helps pay for medical care for individuals with limited income and resources. Both programs provide assistance for nursing home care, but there are some key differences between the two.
First, it’s important to understand the eligibility requirements for both programs. Medicare only covers short-term stays in a nursing home, typically for up to 100 days, following a hospital stay. In order to be eligible for Medicare coverage, the individual must have been hospitalized for at least three days and require skilled nursing or therapy services that cannot be provided at home.
Medicaid, on the other hand, provides coverage for long-term nursing home care for those who meet the program’s income and asset requirements. Eligibility requirements vary by state, but generally, an individual must have limited income and assets to qualify for Medicaid coverage.
To apply for Medicare coverage for nursing home care, the first step is to have a qualifying hospital stay of at least three days. After the hospital stay, the hospital’s discharge planner or social worker will coordinate the transfer to a skilled nursing facility that participates in the Medicare program. The nursing home must be certified by Medicare and provide the necessary skilled nursing or therapy services to qualify for coverage. Medicare will cover the full cost for the first 20 days of the nursing home stay, and then a daily copayment applies for days 21 through 100.
To apply for Medicaid coverage for nursing home care, the individual must submit an application to their state’s Medicaid agency. The application will require information about the individual’s income, assets, and medical condition. The Medicaid agency will then review the application and determine whether the individual meets the program’s eligibility requirements. If approved, Medicaid will pay for the individual’s nursing home care.
It’s important to note that not all nursing homes accept Medicaid. It’s important to research and find a nursing home that accepts Medicaid before applying for coverage. In addition, nursing homes that accept Medicaid may have a waiting list, and the quality of care may vary.
In summary, applying for nursing home care paid by Medicare or Medicaid can be a complex process, but it’s important to understand the differences between the two programs and their eligibility requirements. Medicare provides short-term coverage for skilled nursing and therapy services following a hospital stay, while Medicaid provides long-term coverage for those with limited income and resources. To apply for Medicare coverage, a qualifying hospital stay is required, while an application to the state’s Medicaid agency is required to apply for Medicaid coverage.
Medicare-Adviser.com can help you with many aspects of Medicare, including coverage options, enrollment periods, and how to get the most out of your Medicare coverage. It publishes free educational resources articles covering all aspects and parts of Medicare including Medicare Advantage plans, Medicare Supplement plans as well as Prescription Drug plans (Part D). With help, you can have peace of mind and focus on your retirement and health rather than worrying about the complexity of Medicare. Medicare-Adviser.com offers FREE consultations and can also connect you with a FEE-ONLY (non-commissioned) professional. Individuals looking for help can also visit 1800ADVISER.COM to browse biographies of individual Medicare experts and choose one or more to connect with.
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