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Medicaid Qualifications You Need to Get into a Nursing Home

There are many ways that you can get help when paying for your nursing home.

With the growing costs of everything these days. It is important to figure out just how you can get some extra help with getting into a nursing home so that you can enjoy your retirement without having to worry about your bills.

There are ways that you can make this possible. Things like your social security, Medicaid, and Medicare can help you.

Costs of Nursing Homes Today

Before you go into getting the financial help you’ll need when you plan to get into a nursing home, it is crucial that you know the numbers first.

In 2018, the average cost for a shared room in a nursing home is $235 daily. This is an amount that can be hard to afford for most people in the US. Of course, this amount varies depending on which state you choose to stay in. But still, the cost of a nursing home facility can still reach upwards of $150 at its cheapest.

Difference between Medicaid And Medicare for Nursing Homes

Now you may think that Medicaid and Medicare are the same things, right? Not at all. There is a stark difference between the two and you should know what they are before you go and try to get either of them.

What is Medicaid?

Medicaid is created as a public assistance program to cover medical needs for those who have low income. This means that they are only granted to those who really are in need financially.

Another thing you should take note about Medicaid is that it is a state-federal program. This means that the state you are in operates the system and goes by the federal guidelines given to them. The funding for this program is also different between the two.

What is Medicare?

Unlike Medicaid, Medicare is an entitlement program for medical purposes. This means that you’ll be able to get this if you are eligible for social security and you are over 65 years old.

This is easier to get since it is run by the federal government as long as you meet their eligibility. If you have a permanent disability or end-stage renal failure, you can also be qualified for this program even if you haven’t reached the age requirement.

Benefits of Nursing Home Financial Assistance

Nursing homes can cost quite a lot if you plan on just paying out of pocket without any financial help. We’ve gone over the average costs of how much you’ll have to pay per day. This will only add up as the weeks and months go by and you’ll soon find yourself with little or no money left. This is why you should look into the advantages of getting programs like Medicare and Medicaid.

Medicare Benefits for Use in Nursing Homes

When it comes to helping with the costs of nursing homes, Medicare’s benefits can be limited. This is because this program is intended for those who don’t require long-term assistance. It was made for skilled nursing care for a limited time period. This is also referred to as convalescent care.

Does Medicare pay for nursing homes for the long term? No. The Medicare coverage reaches only up to a maximum of 100 days. They will pay for your nursing home care 100% for the first 20 days and only 80% for the rest of the 80 days that you will be staying.

However, you have the option to get the Medicare Supplemental Insurance to help pay for the remaining 20% of the cost. There is an exemption to this. If the nursing care facility also acts as a psychiatric hospital and you are in need of this type of care, then the assistance can be extended to reach 190 days.

Another limitation to Medicare is that this only covers skilled nursing care for those in recovery from injuries and not long term illnesses. So if a person is suffering from dementia instead of a leg fracture, you won’t likely get the coverage needed.

Medicaid and Its Benefits for Nursing Homes

Medicaid covers almost 65% of the costs for nursing homes in the US. However, there are certain requirements that are needed for you to get coverage from this program.

The main thing is that you should have a certain level of income for you to be eligible. If your assets and income equal to more than the amount that is required by your state, then you are likely not to get it.

However, if you do qualify, Medicare can pay for your nursing home costs 100% at any of their approved nursing homes.

Eligibility For Financial Assistance

Now that you know the benefits of both options for financial assistance for nursing homes, you should now find out if you are eligible for either one of them.

Here is what you need to know:

Are You Eligible for Medicare?

Medicare, although limited when it comes to nursing home coverage, is much easier to be eligible for than Medicaid. As long as you are 65 and above and are entitled to social security benefits, you can get this program.

There are no residence, marital status, or financial requirements needed to be able to get coverage from Medicare. However, you will need to have been injured or in recovery from a three day or more hospitalization to get the skilled nursing care coverage they have for the short term.

The main thing to take note of when applying for Medicare is that you have to do so before you get to the age of eligibility to avoid having to pay for late payment penalty fees. Enrollment should be done at least 3 months before your 65th birthday.

Depending on your income level, you can also be eligible to get Medicaid along with Medicare coverage.

Medicaid Qualifications for Eligibility

The requirements for eligibility for Medicaid depends on which state you are in. Although each state’s program has to adhere to federal guidelines, they are still open to changes based on how the state sees fit. The one constant is that there is a financial requirement that you will need to meet.

It depends on the state you are residing in on how much your assets and income should amount to each year. There are also a lot of restrictions when it comes to this so it’s best that you check with a lawyer while applying to this program.

Nursing Home coverage of Medicare and Medicaid

Although Medicare can cover the costs of indefinite stays in nursing homes, the coverage for this is very limited. It only pays for your medical expenses and your stay in a skilled nursing facility.

It does not cover such things as ADLs or activity for daily living. This means that things like assistance in eating and dressing up aren’t covered.

However, all the other benefits that it offers is still provided no matter if you are living at home or at an assisted care facility.

With Medicaid, the coverage depends on the state that you’re in and also the nursing home facility that you go to. This program does pay for all your costs for long term care but the conditions and benefits really vary with each state.

You will have to go to your local Medicaid Program to find out what you should expect. But most of the time, daily living care like bathing and eating is covered.

How to Apply For Medicaid and Medicare

Medicare comes with a lot of options that you can choose from. This depends on the medical coverage that you will be needing. You can pick any of the plans available and still be covered for the short term nursing home stay.

You can go to the Social Security Administration to enroll. You can also go to their website to sign up online and get to see all the benefits and coverage that their plans have to offer.

When it comes to Medicaid, the best thing to do is to look into your state’s program. Like the benefits covered, the costs you’ll have to pay will depend on the terms and conditions of the state’s program that you fall under. You can go to to check out the program and nearest office in your area.