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Medicare and Medicaid continued...

Medicare Coverage of Skilled Nursing Care Facilities

In order to receive care in a nursing home under Medicare:

  • You must have had a three-day hospital stay prior to admission into the skilled nursing facility.
  • You must be admitted into the skilled nursing facility within 30 days of discharge from the hospital.
  • You must enter the skilled nursing facility for treatment of the same condition for which you were hospitalized.
  • You must require daily skilled care.
  • The condition must be one that can be improved by admission to the facility.
  • The facility must be Medicare-certified.
  • Your doctor must write a care plan. The care plan must be carried out by the skilled nursing facility. (Once the patient meets the level of functioning laid out in the care plan, Medicare will no longer pay for services.)

Medicare Coverage of Home Care

In order to receive home care under Medicare:

  • You must be homebound.
  • The doctor must certify a plan of care.
  • Care must be needed on a non-continuous basis.
  • Care cannot exceed 35 hours per week or 8 hours per day.
  • Physical or speech therapy must be provided on a "necessary and reasonable" basis. There are no restrictions on the number of days or hours per week of these therapies.
  • If you qualify for home health care, you are entitled to a home health aide to provide some personal care.

What Is Medicaid?

Medicaid is a joint federal-state health insurance program providing medical assistance primarily to low-income Americans. It also is available to people underage 65 if they are blind or disabled.

The purpose of Medicaid is to provide preventive, therapeutic, and rehabilitative health services and supplies that are essential to attain an optimum level of well-being.

How Do People Receive Medicaid Benefits?

There are two ways to receive Medicaid:

  • Supplemental Security Income (SSI) -- People who receive a cash grant under SSI and Aid to Dependent Children are automatically eligible for Medicaid benefits.
  • Medicaid spend down -- This is similar to a deductible or a co-payment that you must pay every month. Once you meet your "spend down" amount, you are eligible for Medicaid for the remainder of the month.

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