The vast majority of nursing home stays are paid for either through Medicaid or through private means that may include long term care insurance or paying directly out of pocket.
A distant third in paying for nursing home coverage is Medicare. Medicare pays for nursing home coverage in very limited circumstances. These limited circumstances mean that people should not expect that Medicare will pay for a potential nursing home stay.
Medicare only pays for nursing home care following a hospital stay lasting three days or more, not including the day of discharge. The patient must have been admitted to the hospital for those three days and not merely held in observation awaiting diagnosis.
Additionally, the stay in the nursing home must be for the same reason that the patient received hospitalization. The nursing home stay must also take place within thirty days of discharge from the hospital. Furthermore, the person must be in the nursing home to receive daily skilled care in connection with the medical condition they were hospitalized for. This skilled care is prescribed by a doctor and carried out by a nurse or physical therapist. A typical course of care may be physical therapy and observation following an operation.
Medicare also further limits its nursing home coverage by only paying the full cost of the nursing home stay for twenty days. After twenty days, patients must pay a sizable copayment for their continuing stay. This copayment is typically covered by Medigap plans, but might not be covered by Medicare Advantage plans. The coverage ends entirely when the prescribed course of skilled care ends or reaches 100 days.
These restrictions also leave out nursing home stays that become necessary due to an inability to function at home. Even if the inability to function at home is due to a degenerative condition, such as Alzheimer’s, Medicare will not cover the cost of the stay at a memory care facility.
To prepare for the possibility of a nursing home stay, individuals should meet with a local elder law attorney to develop a plan that will protect their assets from the costs of nursing home care. This planning is more effective the longer it is before the nursing home stay becomes necessary, so individuals should begin planning with an elder law attorney as soon as possible.
To develop a plan to protect your assets from a potential nursing home stay, please call Martha C. Brown & Associates at (314) 962-0186.