What Does Medicare and Medicaid Cover in the Nursing Home Setting?

Coverage by Medicare and Medicaid are very different within a nursing home setting. The following information will provide you with an overview of what is covered through each payer and where to get additional information should you have further questions.

Here are two great tools to help you understand how to pay for nursing home care.

                    
(Click Image)                           (Click Image)
How Do I Pay for                      Planning for Nursing
My Nursing Home Care?            Home Costs Worksheet

 

Medicare

Medicare is a health insurance program for people over the age of 65 and certain disabled individuals. There are a number of Medicare stipulations that limit its long-term care coverage.

• You are only eligible for Medicare nursing home coverage after a hospital stay of at least three days. In addition, this coverage requires substantial insurance co-payments after the first 20 days, and can be used for no more than 100 days.
• Medicare does not usually cover assisted living costs. However, if you contract short-term services through a home care agency while living in an assisted living, Medicare may cover this care.
• Medicare covers homecare only if the elderly individual is homebound and needs therapy or skilled nursing care, according to their physician's plan.
• The new brochure How Do I pay for Nursing Home Care? is now available for printing and distribution to your residents and their families. 

The limitations of Medicare can be explained by the fact that the Medicare insurance program is intended to cover services that will help an elderly person recover from a medical problem. It may not extend coverage for people with chronic care needs, for example Alzheimer's patients. For more information visit www.medicare.gov

Medicaid

Medicaid pays for the majority of nursing home costs, covering nearly 65 percent of all nursing home residents. Medicaid is a joint state-federal program that aids individuals who fall under a certain poverty level determined by the state. Medicaid was originally intended for low-income individuals but because many private pay nursing home residents "spend down" their assets in under a year, it covers elderly people from all walks of life. Each state Medicaid office sets reimbursement rates that are lower than the nursing home private pay rates.
 

Medicaid does not cover assisted living or continuing care retirement communities (with the exception of their skilled nursing units). It pays for care only at nursing homes and Intermediate Care Facilities for the Mentally Retarded. In some states, however, Medicaid may cover home and community-based services.

Kansas Medicaid

All nursing homes are required to provide the following as routine services and/or supplies:

• General nursing services (for example: incontinence care and supplies, tray service, meal feeding, catheterization, etc.)
• Items furnished routinely to all residents, including water pitchers, basins, bedpans, dressing gowns, shampoo, mouthwash, deodorant, and toothpaste
• Items stocked routinely at nurse's station such as antacids, aspirin, and suppositories
• Items expected to be in health facilities, such as ice bags, traction equipment, canes, crutches, walkers, wheelchairs, and I.V. poles
• Dietary supplements and supplies, such as vitamins and laxatives
• Therapy services, including occupational, physical, respiratory, and speech
• Recreational / activity services
• Transportation to/from doctors appointments or medical treatments, and for shopping and outside activities
• Clean bed, linens, and towels
• Basic personal laundry
• Hair and nail hygiene services

The above list is not intended to be all-inclusive. For additional information visit the Kansas Department on Aging