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How To Pay For Skilled Nursing Stay

Most people who move into a nursing home begin by paying for their care from private funds and out-of-pocket. In order to qualify for Medicaid and have the government pay for it, you must first use up all your assets and resources. After that, you can become eligible for the federal program.  Medicare covers skilled care only. See below more information on Medicaid and paying for nursing home care.

Out-of-pocket

Self-funding for the well-planned consumer and financially fortunate individual. If you haven’t purchased long-term care insurance, you will need substantial assets that give a flow of income and cash, consistently. 

Long-Term Care Insurance

A long-term care policy pays a specified amount for nursing home care for a specified number of years in one’s lifetime. It’s designed to help supplement your care and protect your assets by paying for the expenses-the amounts set in your policy. 

Depending on the policy you buy and your plan of care, a long-term care policy can help pay for other services like home care, nursing home and assisted living facilities and other options.

Medicare

Medicare is a federal government program that pays for hospital and medical insurance for people 65 years of age and older, and to certain ill or disabled persons. It also pays for 100 days of care in a skilled nursing home facility per benefits period. It pays for 100 percent of the care given in a skilled nursing home for the first 20 days but only after a three-day hospital stay. Starting on day 21 there’s a co-payment for the remainder of the stay.

Medicare Part A is “hospital” insurance and Medicare Part B is an optional supplementary medical insurance for a small monthly premium.

Medicaid

Medicaid is another federally funded government program that pays for certain health services and nursing home care for people with low incomes. Medicaid also pays for some long-term care services at home and in the community. Medicaid contracts with privately owned nursing facilities and helps cover the costs for those who qualify.

Medicaid has limitations on the assets you can have and the income you can receive before you are eligible for benefits. Who is eligible and the types of services given are different in each state. Restrictions apply to transferring assets to heirs to qualify for Medicaid.

Qualifying for Medicaid

At the beginning of your nursing home stay, you may have to pay out-of-pocket for a portion or all of the nursing home care because you do not qualify for Medicaid. If you do not have enough money to pay for the room and board, Medicaid may pay part. The amount you owe depends on your income and deductions. The state will try to recoup the funds from the estate after the person passes away. Medicaid cannot recover the funds from your home if a spouse, brother, sister, adult child was living there at least one year before the nursing home admission.

Most people reduce their assets before qualifying for the federal and state program. When calculating eligibility, Medicaid has rules about what can and cannot be regarded as an asset. Other rules apply to married couples allowing them to protect a certain amount of assets and income.

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Our DIRECTOR OF FINANCE and SOCIAL WORKER work hard to help you make sense of all the insurance options and eligibility requirements. You don’t have to figure this out alone. We’re here to help!