Medicare and Medicaid

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Medicare and Medicaid are federal and state assistance programs. Some people qualify for both programs and are called “dual eligible.”

Medicare

Medicare, a health insurance program administered by the federal government, is available to people who are age 65 or older, permanently disabled, or affected by kidney failure or long term kidney disease.There are four different parts of Medicare. Each covers specific services:

  • Medicare Part A (Hospital Insurance)—includes limited nursing care facility coverage
  • Medicare Part B (Medical Insurance)
  • Medicare Part C (also known as Medicare Advantage)
  • Medicare Part D (Medicare Prescription Drug Coverage)

Medicare does not provide a comprehensive long term care component. In general, it does not pay for assisted living costs, though it may cover short term services, such as on-site therapy. If certain conditions are met, Medicare offers limited coverage for Medicare beneficiaries who require Skilled Nursing Care or rehabilitation care services. For days 1–20, Medicare will pay 100% of covered services; for days 21–100, you or your loved one will need to pay a daily copayment. The daily copayment can change each year. In 2011, it was $141.50 per day. To receive coverage, you or your loved one must have been admitted to a hospital for at least a three-night stay just prior to receiving care from a Medicare certified Skilled Nursing center.

To learn more about Medicare coverage of Skilled Nursing Care center costs, contact your state Medicare Fiscal Intermediary or State Health Insurance Assistance Program (SHIP)Visit the Helpful Contacts section of the Medicare website for contact information. You can also download Medicare Coverage of Skilled Nursing Facility Care, a publication detailing Medicare coverage.

For general Medicare information, visit the Official U.S. Government Site for Medicare or call 1-800-MEDICARE. If you are calling on behalf of a loved one, you will need written permission from that person authorizing the release of personal information. Download the “1-800-MEDICARE Authorization to Disclose Personal Health Information” Form.

To apply for Medicare, visit the Official Website of the U.S. Social Security Administration or contact your local Social Security Administration office.

Medicaid

Medicaid is a joint federal and state health insurance program available to those with limited income and resources. Eligible individuals include pregnant women, children age 19 or younger, persons age 65 or older, and those who are blind, disabled or in need of nursing home care. Medicaid will pay for Skilled Nursing Care, provided the Care center is certified.

If your income is limited, apply for Medicaid, even if you aren’t sure whether you qualify or not. A qualified caseworker will review and determine your eligibility. Because Medicaid is based on financial need, applicants are asked for extensive information, such as family composition, income, property and banking or investment resources. The Spousal Impoverishment Protection Law helps a Skilled Nursing Care center spouse keep some of the couple’s income and assets.

For more information on Medicaid, visit the U.S. Department of Health & Human Services  Centers for Medicare & Medicaid Services (CMS), or contact your local or state Medicaid office.