Understanding Medicare vs. Medicaid for Nursing Home Care

Many seniors enter a skilled nursing facility following a hospitalization for short-term rehabilitation and skilled nursing care covered by Medicare. Medicare coverage for skilled nursing facility care is intended to be short-term and is different from Medicaid coverage for ongoing long-term nursing home care.

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Original Medicare Coverage for Skilled Nursing Rehabilitation

Under Original Medicare Part A, when Medicare's requirements for skilled nursing facility coverage are met:

Days 1–20: The individual has $0 daily coinsurance after the applicable Part A deductible.
Days 21–100: The individual is responsible for a daily coinsurance amount.

After Day 100: Original Medicare Part A no longer pays for the skilled nursing facility stay during that benefit period.

Medicare coverage is not guaranteed for the full 100 days. The individual must continue to meet Medicare's requirements for skilled nursing or rehabilitation services. Once the individual no longer meets these requirements, Medicare coverage for the skilled nursing facility stay may end.

Original Medicare generally does not cover ongoing long-term or custodial nursing home care.

What If You Have a Medicare Advantage Plan?

Medicare Advantage plans do not necessarily follow Original Medicare's cost-sharing structure.

Medicare Advantage plans may have their own copayments, cost-sharing requirements, contracted provider networks, and coverage requirements for skilled nursing facility care. An Advantage plan may charge copayments even during the first 20 days of a skilled nursing facility stay.

Families should contact their individual Medicare Advantage plan to verify coverage, copayments, authorization requirements, and whether the skilled nursing facility participates in the plan's network.

Where Medicaid May Help

For individuals who qualify for full Medicaid benefits in addition to Medicare, Medicaid may help with Medicare cost-sharing expenses, depending on the individual's Medicaid coverage.

When Medicare rehabilitation ends and an individual requires ongoing nursing home care, Florida Long-Term Care Medicaid may help cover the cost of long-term nursing facility care for individuals who meet the applicable medical and financial eligibility requirements.

This is often where the transition from Medicare rehabilitation to Long-Term Care Medicaid becomes important—and where understanding nursing home level of care begins.

The transition from Medicare rehabilitation to long-term nursing home care can happen quickly, and the cost of nursing home care can place a significant financial burden on a family. That is why it is important to begin the Medicaid process as soon as long-term care becomes a possibility. Our Florida Medicaid Specialists will guide you through the requirements, coordinate the necessary information and documentation, and help keep your application moving forward. Acting promptly can help prevent unnecessary delays in Medicaid coverage and potentially save your family thousands of dollars in out-of-pocket nursing home expenses.

You Don't Have to Navigate Medicaid Alone

Navigating Florida Long-Term Care Medicaid can feel overwhelming, especially when your family is already facing important healthcare and long-term care decisions. From understanding Medicare and Medicaid benefits to navigating medical and financial eligibility, our Florida Medicaid Specialists are here to guide you through each step of the process.

We help you understand what comes next, prepare for important interviews and assessments, organize and coordinate the necessary documentation, and keep your Medicaid application moving forward. You'll have a knowledgeable and compassionate team by your side—from your first consultation through Medicaid approval.

Our goal is simple: to make the Medicaid process easier for your family and help your loved one access the care and benefits they need to live their best life.

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