There are important differences in medical coverage between these two care options. Outside of private pay and insurance programs, there are two main sources of government funding: Medicaid and Medicare. The biggest difference is that skilled nursing care is covered by Medicare under most circumstances, whereas long-term care services in nursing homes are not.
Under Medicare, the following services are covered at skilled nursing facilities:
Semi-private room (a room you share with other patients)
Meals
Skilled nursing care
Physical and occupational therapy
Speech-language pathology services
Medical social services
Medications
Medical supplies and equipment used in the facility
Ambulance transportation to the nearest supplier of needed services
Dietary counseling
Here is a breakdown of exactly what Medicare covers for a skilled nursing facility:
Up to 100 days in a skilled nursing facility is covered for the most part by Medicare. For 20 days or less, this is fully covered.
Days 1–20: $0 per day
Days 21–100: $167.50 per day to be covered by the patient or insurance
Days 101 and beyond: all costs covered by the patient or insurance
Long-term nursing home care is not covered by Medicare. Most people in Minneapolis, MN pay for nursing home care through Medicaid.
If you do not already qualify for Medicaid, you might be eligible if you have limited income. The income limit for Medicaid generally aligns with a percentage of the Federal Poverty Level (FPL), though exact thresholds can vary by state and program in Minnesota.
Asset limits also apply for Medicaid eligibility. Individuals may be allowed to retain certain assets, while others must fall below a specified threshold. Some assets are not counted, such as a home (if your spouse is living there or you intend to return), one vehicle, personal belongings, and certain burial or life insurance policies.
You may be permitted to “spend down” your assets to qualify for Medicaid by paying for certain types of debts or expenses. Be very careful about transferring any of your assets. Medicaid will review financial activity during a look-back period (typically up to 60 months) from the date you apply for long-term care assistance to ensure transfers were legitimate.
If your income is above the Medicaid limit, you may still qualify through Minnesota’s Medical Assistance “spenddown” program. This allows individuals with higher income to become eligible by applying certain medical expenses toward their excess income. Once those expenses meet the required spenddown amount, Medical Assistance may cover the remaining approved medical costs for that period. Think of it like a deductible — once your medical bills reach a certain amount, Medicaid can begin paying.
