Medicare and Medicaid provide coverage for nursing home care, but the eligibility requirements and coverage details differ between the two programs.
Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities. Medicare Part A covers skilled nursing facility (SNF) care, which includes nursing home care, but only under specific conditions. To be eligible for Medicare coverage of nursing home care, the following criteria must be met:
1. The individual must have a qualifying hospital stay of at least three consecutive days.
2. The individual must require skilled nursing care or skilled rehabilitation services on a daily basis.
3. The individual must be admitted to a Medicare-certified skilled nursing facility within 30 days of the qualifying hospital stay.
Medicare coverage for nursing home care is limited to a maximum of 100 days per benefit period. During the first 20 days, Medicare covers the full cost. From day 21 to day 100, the individual is responsible for a daily coinsurance amount.
Medicaid, on the other hand, is a joint federal and state program that provides health coverage to low-income individuals. Medicaid does cover nursing home care, but the eligibility requirements vary by state. In general, to qualify for Medicaid coverage of nursing home care, an individual must meet certain income and asset limits set by their state.
It's important to note that Medicaid is the primary payer for long-term nursing home care, while Medicare is more focused on short-term skilled nursing facility care. If an individual exhausts their Medicare coverage for nursing home care, they may be eligible for Medicaid coverage if they meet the eligibility criteria.
In summary, both Medicare and Medicaid provide coverage for nursing home care, but the eligibility requirements and coverage details differ between the two programs. It's important to understand the specific criteria and limitations of each program to determine if you or a loved one may be eligible for coverage.