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WILL MEDICARE PAY FOR SKILLED NURSING?

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By Nathan R. Palmer

Deciphering between the benefits provided by Medicare and Medicaid can be difficult. It is important to know the difference between Medicare and Medicaid when you or a loved one is seeking coverage of a stay in a long-term care facility (i.e., Assisted Living or Skilled Nursing Facility).

Medicare is a federal health insurance program available to individuals 65 years of age and older as well as individuals with certain disabilities or medical conditions who are younger than 65 years of age. Medicare does not always cover all medical expenses incurred by covered individuals; rather, individuals are required to pay a deductible as well as certain expenses not covered by Medicare.

Medicare Parts A and B are intended to provide coverage for hospital stays and medical visits, respectively. Medicare Part A will pay for up to 100 days in a skilled nursing facility. The requirements for providing coverage are that (1) the patient was admitted to a hospital for at least three days, and (2) entered the skilled nursing facility within 30 days. Medicare Part A will not cover all expenses associated with a stay in a skilled nursing facility. Medicare will cover the first 20 days of the stay, but will only cover a portion of the remaining 80 days. As a result, most people who stay in a skilled nursing facility for an extended period of time will incur a large bill from the facility.

Medicare is not designed to provide coverage for a long-term stay in a skilled nursing facility. Medicaid, on the other hand, may provide coverage for a stay in a skilled nursing facility as long as a patient meets certain Idaho Medicaid eligibility requirements, which requirements include certain resource, income, transfer, and medical need requirements. Idaho Medicaid benefits for long-term care can be a valuable resource for individuals in need of the care provided by skilled nursing facilities.

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