Who Pays for Nursing Home Costs?

Individuals pay for a large portion of their nursing home costs. Medicaid, the payment source for people without sufficient income and assets to pay for themselves, accounts for about 45 percent of all long-term care spending. Medicare, medical insurance for people age 65 and older and those on Social Security disability, accounts for only 11 percent of nursing home costs since Medicare does not pay for nursing home care for the long-term, as some people mistakenly believe.

There are several options that you may consider before placement in a nursing home.nurse and person in a bed

The first step is to ask a Case Manager for an assessment and consultation prior to nursing home placement. Nursing homes often help with these arrangements. There is no charge or obligation for the assessment. The patient may be eligible for in-home care if he or she is found to be eligible by the Case Managers assessment. The fee for in-home care depends on the household income, but is explained in detail before service is ordered.

Regardless whether the patient is eligible for in-home care, or is placed in a nursing home, none of his or her assets house, savings, etc. is immediately taken away from a spouse living at-home, although estate recovery rules may apply. Estate recovery is the repayment to the state for services the patient receives. However, this repayment is not required until the spouse no longer lives in their house.

Also, the spousal impoverishment prevention program may apply if the patient needs in-home or nursing home care. The spousal impoverishment program allows the transfer of almost all, if not all assets into only the name of the spouse at-home. This allows the spouse at-home to keep a sizable portion of the household monthly income and family assets for his or her benefit, and they do not count toward eligibility for the patients nursing home services. This rule works well for both the in-home or nursing home care.

Finally, please do not confuse Medicare with Medicaid. Medicare is a health insurance program and never "takes everything away" from someone who uses it. However, Medicare only pays for short-term skilled nursing care. The Medicaid program often pays for long-term nursing home care and may require estate recovery for repayment of this care. But, remember that the spousal impoverishment prevention program may help alleviate some of this concern for your mother.

Medicare pays for skilled nursing home care. This is not the same as long-term nursing home care. To be eligible for skilled care, the Medicare beneficiary must meet several conditions, including having been hospitalized for at least three consecutive days for a related illness prior to being admitted into a Medicare-approved skilled nursing facility. Medicare pays for the first 20 days of approved stays in a skilled facility, but coverage is limited beyond 20 days.

Individuals who receive long-term care in a nursing home not covered by Medicare must pay the entire cost themselves whether it is from their Social Security check, pension, or savings. If individuals don't have sufficient income or savings to pay for long-term nursing home costs, they spend down their income, savings, and other assets to help pay for their care until they are eligible for Medicaid, a Public Aid payment source.

For more information on Medicare, Medicaid, Prevention of Spousal Impoverishment, and services for senior adults, call the regional Ombudsman, your local senior center, or Contact the Egyptian AAA.

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