Medicaid is a joint state and federal program that pays for over 65 percent of resident days of care in Pennsylvania’s nursing homes. Medicare, a federal program, pays for approximately 12% of care.
The Medicaid program is designed to help people with low income and virtually no assets pay for health care. Thirty percent of the Medicaid recipients in nursing homes today have qualified for Medicaid by exhausting personal assets to pay for the care and services they receive.
Medicaid pays an average of $7.50 per hour for care and services in nursing homes. According to the BDO Seidman report, nursing homes costs of care for Medicaid patients exceed the actual Medicaid reimbursement by $13.92 per day.
Medicare is a federal health insurance program for people 65 and over and certain disabled people under 65. It does not provide a comprehensive long-term care component and generally does not cover personal care home costs but may pay for short-term services (e.g. physical and other therapies) contracted through a home health-care agency and provided to the resident at the personal care home. Medicare covers only those nursing home services rendered to help someone recover from an acute illness or injury. Medicare is administered by the federal government’s Centers for Medicare and Medicaid Services (CMS) and is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B).
Nursing home coverage falls under Part A of Medicare and is very limited. If certain conditions are met, Medicare only pays fully for the first 20 days of care in a skilled nursing home.
For the 21st through the 100th day, the patient must share, or co-pay, for the cost of care by paying a daily coinsurance rate, which changes yearly. (This is typically what a Medigap policy covers.)
* A semi-private room
* Meals, including special diets
* Regular nursing services
* Rehabilitation services
* Drugs furnished by the facility
* Medical supplies
* Personal convenience items
* Private duty nurses
* Extra charges for a private room