Medicare is a federal acute care insurance program that is administered by the federal government. Medicaid is also a Federal program, but it is run by the State. The two programs serve different purposes. For nursing home care, Medicaid is the program most of us look to for help in paying the bill on a long term basis. Medicaid will pay either some or the nursing home’s entire bill, depending upon your individual financial circumstances, for as long as you continue to qualify financially. Medicaid eligibility rules cannot be neatly summarized and the rules differ depending upon whether you are married or single. If you are married, the rules provide for some basic asset protection for the healthy spouse, including a house, car and a minimum amount of money. There is also an income protection for the healthy spouse that can be as high as $2,500 per month.

Medicare has a limited nursing home benefit that does not exceed 100 days. You will only receive the full 100 day Medicare benefit as long as your health improves at the nursing home. If your health plateaus, you will no longer be eligible Medicare benefits at the nursing home. While you are Medicare eligible, Medicare will pay the entire bill at the nursing home for the first 20 days. For the next 80 days, Medicare will pay the entire bill except for $128.00 per day, (increased each year for inflation). You are responsible for the $128.00 per day. This is called the “Medicare co-pay” but most people have a supplemental health insurance policy that pays this co-pay.  For further information, see our publication "Discharged from a Nursing Home".