Positive Aging SourceBook

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Posted by Positive Aging SourceBook on 05/26/2022

Nursing & Rehabilitation + Paying for Nursing Home Care

Nursing & Rehabilitation + Paying for Nursing Home Care

At a nursing care center, care is administered by professionals under the direction of a physician. Many facilities also offer sub-acute, respite, rehabilitation and other short-term care. Rehabilitation services can be especially helpful for individuals who are recovering from surgery, an illness or any other life-changing event.

Who is Nursing Care for?

These communities serve as permanent residences for individuals who are too sick or frail to live at home, or as temporary facilities during a recovery period. Some residents enter a nursing care center for a short-term stay after a surgery or illness, while others enter on a more permanent basis.

Who Pays for Nursing Care?

Medicare, Medicaid, private insurance and personal assets are all used under various circumstances to pay for services in a nursing care facility. If a facility is not certified by Medicare and Medicaid, the care will have to be paid for entirely with personal funds.

In general, Medicare pays for skilled nursing care following hospitalization for the same illness or condition at 100 percent of the cost for days 1 – 20. Some long-term care insurance pays for nursing care centers; insurance payments are usually a fixed amount for a specified number of qualified days.

The basic daily rate is the standard charge the nursing care center bills to all residents, which covers the fundamental services every resident receives, including rent for the room, housekeeping, meals and general nursing care. It is important to understand all the services and amenities that are not included in the basic daily rate.

What to Look for in Nursing Care

Before choosing a community, contact the Long-Term Care Ombudsman Program of your Area Agency on Aging. Ombudsman programs promote the highest quality of life and care for residents of nursing facilities and can help families and staff with inquiries and complaints.

Paying for Nursing Home Care

Nursing home care can be expensive. There are many ways you can pay for nursing home care. For example, you can use your own money, you may be able to get help from your state, or you may use long-term care insurance.

Most people who enter nursing homes begin by paying for their care out-of-pocket. As you use your resources (like bank accounts and stocks) over a period of time, you may eventually become eligible for Medicaid.

Will Medicare pay for nursing home care?

Medicare generally doesn’t cover long-term care stays in a nursing home. Even if it doesn’t cover nursing home care, you’ll need health coverage for hospital care, doctor services, and medical supplies while you’re in the nursing home.

Part A covers skilled care provided in a skilled nursing facility (SNF) under certain conditions for a limited time. Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapies to treat, manage, and observe your condition, and evaluate your care.

Medicare covers certain daily skilled care services on a short-term basis (up to 100 days in a benefit period). For more information on Medicare’s coverage of SNF care, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Personal resources

You can use your personal money and savings to pay for nursing home care. Some insurance companies let you use your life insurance policy to pay for long-term care. Ask your insurance agent how this works.

Important: Be sure to get help before using either of these options. There are important issues you need to understand.

Help from your state (Medicaid)

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Most health care costs are covered if you qualify for both Medicare and Medicaid. Most, but not all, nursing homes accept Medicaid payment. Even if you pay out-of-pocket or with long-term care insurance, you eventually may “spend down” your assets while you’re at the nursing home, so it’s good to know whether the home will accept Medicaid.

Check with the nursing home to see if they accept people with Medicaid. Medicaid programs vary from state to state. Most often, eligibility is based on your income and personal resources. Many states have higher Medicaid income limits for nursing home residents. You may be eligible for Medicaid coverage in a nursing home even if you haven’t qualified for other Medicaid services in the past.

Sometimes you won’t be eligible for Medicaid until you’ve spent some of your personal resources on health care. Generally, even if you’re eligible for Medicaid, all of your income (except for a monthly personal needs allowance and amounts considered necessary to support your spouse and family living in the community) will go to pay your nursing home expenses and Medicaid will cover the rest. To get more information on Medicaid eligibility in your state, call your local Medicaid office.

Information excerpted from a Centers for Medicare & Medicaid Services publication. More information is available online at medicare.gov.

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