Medicare and Medicaid

MEDICARE, administered by the Social Security Administration, is a federal insurance program for persons 65 and over, or persons disabled for at least two years. Medicare pays for only twelve percent of the nursing facility care provided in Idaho.

If certain criteria are met, Medicare may pay the bill (for covered services only) for the first 20 days in each benefit period. Experts on Medicare determine the amount to be paid, which the nursing facility can accept as full payment. Some of the bill can be paid for covered services for up to an additional 80 days, if the patient qualifies.

The Medicare patient's case is, however, routinely reviewed by the Social Security Administration. When these reviewers determine that the patient no longer requires skilled nursing facility services, Medicare payments are ended.

MEDICAID, on the other hand, is a federal-state financed assistance program for certain needy and low-income persons of all ages. States design their own programs within broad federal guidelines. Thus, Medicaid programs will vary from state to state. Medicaid pays only for basic care needs, excluding amenities such as private rooms, etc.

You may need to complete applications for both Medicare and Medicaid. Please discuss this with your social worker, the facility's administrator, or local aging office.

Data on Idaho's regulations are available from the Idaho Department of Health and Welfare, which administers the program in Idaho.