Medicare-A skilled benefits are available to Medicare beneficiaries in a skilled nursing setting if beneficiary has a 3 midnight hospital stay and requires skilled therapy in a skilled nursing home setting.
Beneficiaries are allowed up to 100 Medicare-A skilled days of therapy if actively participating and progressing. Medicare pays for the first days completely. The next 80 days are co-payment days. Medicare pays 80% of the cost. The other 20% is paid by co-insurance, Medicaid or private pay. Medicare-B benefits can be used for ongoing therapy after 100 days are used until annual cap amount is reached.
Medicaid is the primary payer in long-term care facilities. Medicaid for long-term care has 2 requirements, medical necessity and financial need. Medicaid applications for long-term care are available at County Department of Human Services. Financial disclosure is required regarding any resources or income levels, including real property value, life insurance, sources of income ie., retirement, social security, bank accounts, savings accounts, CD's, etc.
Medicaid recipients are only allowed to have a total of $2000.00 in resources. Community spouses are allowed to keep $119,220.00 in resources and still qualify for Medicaid for spouse in long-term care. An assessment of medical necessity must be completed prior to nursing home admission. After Medicaid is approved Medicaid pays for a portion of cost of long-term care facility charge and the recipients social security or retirement benefits pay the resident liability determined by Medicaid less $79.57 that recipient may keep for personal needs.