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Sep 15, 2015 by |

Medicare and Medicaid for Nursing Homes

Medicare and Medicaid programs differ in the way that they pay for nursing home care. It is important for nursing home residents and their loved ones to understand the coverage they have under their particular program.
Medicare coverage functions like a health insurance policy, with either the beneficiary or the beneficiary’s spouse having made contributions to the Social Security program through payroll deductions. Medicaid beneficiaries do not need to have contributed to the Social Security program, but must have limited resources and income to qualify. The Medicaid rules vary slightly by state to state, as Medicaid money comes from both the state and federal governments. Medicaid can be considered a safety-net healthcare program for those unable to pay their medical bills.

Medicaid will pay indefinitely for nursing home care for residents who remain financially eligible and require nursing home care. A resident may have to pay a monthly deductible, which generally varies based on his or her income and that of his or her spouse.

Medicare, on the other hand, will pay for nursing home care for only a limited amount of time, which is generally a maximum of 100 days per benefit period. Only 20 of those days are paid in full, with the remaining 80 days costing a patient $157.50 daily. Medicare Supplement policies, also known as Medigap, can cover this daily co-payment.

Medicare has additional limitations on paying for nursing home care. It will only cover nursing home care following at least a three-day stay in a hospital, and only if the care received in the nursing home is related to the hospital visit. It is also only available for patients who require daily or almost daily skilled rehabilitation services.

Evans Law Firm, Inc. handles nursing home abuse and other elder abuse lawsuits, as well as Medicare fraud and Medicaid fraud cases. If you or a loved one has a potential nursing home abuse claim, please contact Evans Law Firm, Inc. at 415-441-8669 or via email at

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