Pine Crest Pointers: Medicare vs. Medicaid
By Ginger Osness
RN, Admissions Coordinator, Pine Crest Nursing Home
Have you ever wondered what the difference is between Medicare and Medicaid? You are not alone. In fact, often times, some think it is the same thing.
Medicare is a benefit that is available from the federal government. It is an option when you turn 65, or are younger and have a disability. Some chronic illnesses can also qualify you for Medicare benefits. There is an option to buy a Medicare HMO or a Medicare supplement.
Wisconsin Medicaid is a state benefit, which you also must qualify to receive. You must be a resident of Wisconsin who is in need of health care and whose financial situation is characterized as low income. Medicaid is not the same as Badger Care.
How do these work in a skilled nursing facility (SNF)?
Each Medicare plan is different. There are different rules as to when Medicare will cover in a nursing home, depending on your plan. Regular Medicare requires a three-midnight hospital stay to qualify for a nursing home stay. Medicare HMOs have in- and out-of-network facilities, and do not require a three-midnight stay in a hospital. These plans have a case manager that follows your progress at the SNF.
Medicare supplements are just that: they supplement coverage that Medicare does not, such as co-pays or deductibles. Some Medicare supplements will offer 30 days in a SNF when a hospital stay was present, but not three days.
How does Medicaid work in a SNF?
Medicaid can help pay for a stay at a SNF, in the short term and long term, as long as the holder continues to meet the qualifications. Medicaid can help cover costs and provide extra resources in the community. It can also help pay toward a SNF stay. The amount the plan will pay for determined by the state of Wisconsin.
For more information regarding Wisconsin Medicaid, please contact your local ADRC and ask for a Medicaid Specialist.
About Pine Crest
Pine Crest Nursing Home is a 160-bed skilled nursing facility located in Merrill, Wis. Pine Crest specializes in short-term rehabilitation, long-term care, dementia care and hospice/comfort services for adults. Pine Crest also has a new 20-bed Rehab Unit and 20-bed Special Care Unit. All beds are Medicare and Medicaid certified. Learn more at www.norcen.org/SkilledNursing.