Payment Options

Medicare & Medicaid for Transitional Care

Medicaid

You may be eligible for Medicaid coverage even if you haven’t qualified for other Medicaid services in the past. You may need to spend some of your personal resources on nursing home care before becoming eligible for Medicaid coverage.

There are specific rules regarding what is included as an asset and what is excluded when determining Medicaid eligibility. You cannot legally give away your assets to family members or non-family members to avoid using your assets to pay for your nursing home care. If you give away assets within 5 years of the date you apply for Medicaid (rules can vary by state), you may be subject to a penalty and be ineligible to receive Medicaid benefits.

Note: Federal “spousal impoverishment” regulations protect spouses of nursing home residents from losing all their income and assets to pay for a spouse’s nursing home care. These rules ensure that the at-home spouse has enough money to pay for living expenses. To get additional information on Medicaid eligibility, contact your State Medical Assistance office:

Wyoming Department of Health:www.health.wyo.gov or 307-777-7531 or 866-571-0944

Medicare

Medicare Part A is hospital insurance that helps pay for care in hospitals (inpatient), skilled nursing facilities (inpatient), home health care and hospice. Medicare only covers medically necessary skilled nursing facility care for a limited benefit period of up to 100 days after a minimum 3-day qualifying hospital stay.

You must be admitted into the skilled nursing facility within 30 days of this qualified hospital stay for Medicare to pay skilled nursing facility benefits. Medicare pays for 100% of the care for the first 20 days of a skilled nursing stay. For days 21-100, you will be responsible for a co-pay ($148.00/day in 2013) and Medicare will pay the difference.

Medicare supplemental insurance assists with paying for gaps in Medicare coverage such as deductibles and co-insurance. Most supplemental insurance plans will pay for skilled nursing care, but only when that care is covered by Medicare. If your nursing home stay exceeds 100 days you may be responsible for all subsequent care costs.

Check out these resources for more information:

Centers for Medicare & Medicaid Services (CMS): a federal agency which administers Medicare, Medicaid, and the State Children’s Health Insurance Program. www.medicare.gov/NHCompare/ or call 800-MEDICARE (800-633-4227)

State Health Insurance Assistance Program (SHIP): SHIPs are state programs that receive federal funding to provide health insurance counseling to individuals. SHIPS can provide answers to questions related to Medicare, insurance and health plan decisions and your rights.

Wyoming State Health Insurance Information Program: www.wyomingseniors.com or 800-856-4398

Medicare & Medicaid for Long-Term Care

Medicaid

Medicaid eligibility is based on your income and personal resources. You may be eligible for Medicaid coverage even if you haven’t qualified for other Medicaid services in the past. You might need to spend some of your personal resources on nursing home care before becoming may eligible for Medicaid coverage. There are specific rules regarding what is included as an asset and what is excluded when determining Medicaid eligibility. You cannot legally give away your assets to family members or non-family members to avoid using your assets to pay for your nursing home care. If you give away assets within 5 years of the date you apply for Medicaid (some rules vary by state), you may be subject to a penalty and be ineligible to receive Medicaid benefits.

Note: Federal “spousal impoverishment” regulations protect spouses of nursing home residents from losing all their income and assets to pay for a spouse’s nursing home care. These rules ensure that the at-home spouse has enough money to pay for living expenses.

To get additional information on Medicaid eligibility, contact your state medical assistance office:

Wyoming Department of Health: www.health.wyo.gov or phone 307-777-7656 or 866-571-0944

Medicare

Medicare does not generally cover long-term stays in a nursing home (room and board) to help with activities of daily living like eating, bathing, dressing and assistance with using the bathroom. Medicare only covers medically necessary skilled nursing facility care for a limited benefit period after a 3-day qualifying hospital stay. For more information, check out the resources below:

Centers for Medicare & Medicaid Services (CMS): a federal agency which administers Medicare, Medicaid, and the State Children’s Health Insurance Program. https://www.medicare.gov/quality-care-finder/#nursing-home-compare or call 800-MEDICARE (800-633-4227)

State Health Insurance Assistance Program (SHIP): SHIPs are state programs that receive federal funding to provide health insurance counseling to individuals. SHIPS can provide answers to questions related to Medicare, insurance and health plan decisions and your rights.