Medicare

You must receive the services from a Medicare certified skilled nursing facility. You are given 100 days of Medicare Part A coverage during a benefit period. The day you start receiving hospital or skilled nursing facility benefits is considered the first day of your benefit period. The first 20 Medicare days are paid 100% by Medicare Part A. Medicare will pay for all Medicare-related charges during the last 80 days of your benefit period except for the co-insurance amount.

What does it mean for your benefit period to end?

  • When you have not been in a skilled nursing facility or a hospital for at least 60 days in a row.
  • If you are still a resident of a skilled nursing facility, you must be without skilled nursing care for 60 days in order to renew your benefit period.

It is also important to note that you are not limited to a certain number of benefit periods, but you will need to have another three-day hospital stay and continue to meet Medicare requirements in order to receive another 100-day Medicare benefit period.

Medicaid

Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income. Since Medicaid is a State and Federal funded program, each state offers different eligibility criteria. You will only receive the benefits of Medicaid if the skilled nursing facility that you are a patient of is certified by the government.

Private Pay

Most nursing home patients pay for their nursing home stay out of their own personal accounts. Once funds are depleted and people become long-term patients of a nursing facility, the majority of people are able to receive Medicaid.

Medigap

Medigap is private insurance that helps to fill in the gaps that Medicare Parts A and B do not cover, such as deductibles, co-insurance, or skilled nursing facility services that extend beyond the Medicare benefit period. A Medigap plan will assist in paying skilled nursing care, but only if the care is covered by Medicare.

Long-Term Care Insurance

All long-term care insurance policies differ when it comes to benefits and costs. You may contact the NAIC (National Association of Insurance Commissioners) for more detailed information regarding the different long-term care insurance policies.

Click here for more information about Medicare.