Nursing Home Coverage: Medicare, Medicaid, and Medi-Cal

If you have a loved one who has been admitted to a skilled nursing facility then you probably have heard lots of similar terms you may not completely understand. Terms like Medicare, Medicaid, and Medi-Cal.

Medicare is the federal health insurance program for people 65 and older. It covers a large portion of your medical bills, doctor bills, and hospital bills. It is paid for from monies deducted from your Social Security income. Medicare will usually cover the first 20 days of a skilled nursing home stay, assuming the resident is making progress. If the nursing home resident is not making progress, the resident immediately becomes private pay. Medicare can cover up to 100 days. However, during the last 80 days there is usually a fairly high co-pay (up to $161.00 per day) required. This co-pay varies depending on your secondary insurance coverage.

Medi-Cal is California’s version of Medicaid. Medicaid is a federal program administered by the states. It provides health coverage to low income families, children, people with disabilities, pregnant women, and elderly adults. Medi-Cal has various programs to assist the elderly with long-term care. One of those programs is Medi-Cal Long-Term Care. It is designed to assist with the high cost of nursing home care. Medi-Cal can help you eliminate or reduce what would be owed on co-pays with Medicare during the first 100 days of a nursing home stay and can also secure the funding you need to afford a lengthy stay. The process can take 2-3 months to get approved. This is why applying for Medi-Cal early is so important, and why most nursing homes want you to make the Medi-Cal application immediately. If this is an issue you are facing, give us a call. We will spend the time needed to discuss your situation in detail and give you the answers you need.