Facts About Medicare and Medicaid

Medicare Part A, Medicare Part B, deductibles, coinsurance, Medicaid ... health care payment can be confusing.

This web page offers a simple overview of the types of health care costs Medicare and Medicaid cover specific to skilled nursing facilities. Understanding health care payment and coverage will help you to make more informed decisions for you or your loved one.

What is Medicare?

Medicare is a Federal health insurance program for people age 65 and older, individuals who are permanently disabled for at least 24 months, or those who have End Stage Renal Disease. Anyone who is eligible for Social Security benefits may qualify for Medicare.

Medicare benefits cover skilled nursing costs after a person has been in the hospital for three consecutive days and has been admitted to a nuring facility within 30 days of discharge. The patient must require post-hospital treatment. Medicare coverage is divided into two parts: Part A(hospital insurance) and Part B (medical insurance).

What is Medicaid and what costs does it cover?

Medicaid is a Federal as well as a State-funded program that provides financial assistance for medical services to low-income individuals of all ages. Services offered through this program do not require monthly premiums, but there are strict financial eligibility requirements. In addition, Medicaid may require you to pay a portion of your monthly Social Security income to the nursing home as paritail payment for services (patient liability). There are different eligibility levels depending on the type of care necessary. The West Virginia Department of Health and Human Resources can provide more information on the current State requirements, rules and restrictions.

For other questions regarding Medicare and Medicaid you can contact 1-800-MEDICARE (1-800-633-4227) or the West Virginia Department of Health and Human Resources.