Medicare is a federal health insurance program for people 65 and over and people with certain disabilities under age 65. To be eligible to receive Medicare coverage, residents must require skilled nursing care or rehabilitative care on a daily basis. They must have spent three consecutive nights in a hospital and be admitted to a skilled nursing home within 30 days of discharge from the hospital. Also, a physician must certify that the services required from the skilled nursing home are needed for the same illness for which the resident was hospitalized.
Medicare Part A covers care provided by a skilled nursing home to help residents recover from an acute illness or injury. Medicare provides complete coverage for the first 20 days of skilled care and a portion of the cost for days 21 to 100. During this time frame, residents are required to pay a daily coinsurance rate.
Skilled nursing home services covered by Medicare include:
Medicaid is a health insurance program in which the federal and state governments share the cost of payments to nursing facilities on behalf of eligible residents. Medicaid is for low-income people 65 and over, people who are disabled, people who are blind, and people who need nursing home care. Some people qualify for both Medicaid and Medicare; and Medicaid is sometimes used to help pay for Medicare premiums. People who qualify for both programs are called 'dual eligible'.1
To be eligible to receive Medicaid coverage, residents must meet a state-determined poverty level and certain health criteria. Because Medicaid is based on financial need, extensive information on income and assets is required for qualification.
For qualifying individuals, Medicaid pays for nursing facility services in certified skilled nursing homes. Skilled nursing home services covered by Medicaid include:
Additional insurance is available to supplement Medicare or Medicaid coverage, to pay for additional services. Residents with such insurance coverage should bring a copy of their policy to their local Wingate Healthcare Admissions Staff so that they can determine how to receive the most benefit.
Residents can apply for Medicare at their local Social Security office. Residents can apply for Medicaid at their local Department of Health office or at their state’s Medicaid agency.
Please contact us with any questions concerning payment and billing policies. The Wingate staff is happy to assist you.