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PAYMENTS FOR NURSING HOME CARE

LONG TERM CARE COSTS:

man in wheelchairMEDICARE AFTER HOSPITALIZATION

After a hospital stay of more than three days, if it is determined that a patient qualifies for Medicare assistance for skilled nursing care or physical therapy, Medicare usually pays for the following nursing home rehabilitative care, assuming that they agree that such care is needed:

FIRST 20 DAYS:

Medicare should cover the first 20 days in full. 

THE NEXT 80 DAYS:

Medicare pays 80% of the per day charge for the next 80 days.

AFTER MEDICARE-PAID  REHABILITATION

Starting with day 101, these are the ways of paying for long term custodial care.

PAYMENT BY LONG TERM CARE INSURANCE:

I think this is the very best way to make provision for the payment for long term care but the premiums are expensive and there are age and health requirements.  Therefore it is not an option for many people.

PAYMENT BY VETERANS' BENEFITS:

Some veterans may have some limited benefits through the Veterans Administration.

YOUR OWN MONEY USED TO PAY FOR CARE:

If a person does not own long term care insurance, and ever needs to hire health aides to provide custodial nursing care at home or in a nursing home, assets can be cashed in and used to pay for it privately.

This is the pay method that gives you the most control and options.  It is also the simplest.

Once you pay for your own care until your funds are almost used up, you will then qualify for Medicaid to take over.

PAYMENT BY MEDICAID

To obtain Medicaid coverage, one must qualify financially and submit an application and financial evidence.

Married couples can keep more assets and in some cases the house is an exempt resource for the time being.

Under present law, certain forms of planning are permissible so that part of a person’s assets can go to loved ones, not for the purpose of qualifying for public benefits, but for the purpose of providing for loved ones.

In planning for loved ones, Medicaid's complicated rules must be followed precisely.  You must be very careful not to give away your assets.  If you do, Medicaid may determine that you are disqualified to receive Medicaid payments.  However, there are exceptions.  There are purchases that a Medicaid applicant can spend money on, without disqualification and there are certain relatives to whom certain gifts can be made that will not result in a disqualification.  In some cases a Medicaid applicant's house is not counted as a resource and each Medicaid applicant is permitted to keep a certain amount of money in the bank.

However, the Medicaid laws change rather frequently and so we cannot anticipate what the rules will be for some future time.

We cannot be sure that Medicaid will offer care that is comparable to private pay care.  At present Medicaid usually only offers a shared room in a nursing home.  Some people may find that unsatisfactory for privacy and comfort.  More differences in care may arise in the future as the Medicaid budgets are limited.

See section ASSET PROTECTION PLANNING.

NURSING HOME COMPARISONS

The federal government provides a website that compares nursing homes. 

It lists the number of violations and some detail about each of the allegations, as of the latest government-required quality inspection.
You will find it at:

www.Medicare.gov