top of page
  • sbeigie

Does Medicare Cover My Nursing Home Costs?

Understanding the financing of long-term care can feel like a daunting task. While there are many individuals who have circumstances specific to their situation that need addressing; there are some basics that can be helpful to understand as a foundation of knowledge. The costs associated with long-term care are not negligible. Having a grasp on potential costs and options is beneficial for all families when trying to best plan ahead.

Does Medicare Cover my Nursing Home Stay?

To answer this question, the first thing to understand is that becoming a nursing home resident is not the same thing as going to a skilled rehabilitation center or rehabilitation wing of a facility after an acute medical situation (such as a hospital stay). In the case of skilled rehabilitation, Medicare often will cover a short-term stay at a facility

for therapy and nursing services if deemed necessary by the medical team and insurance provider. While individuals are allotted 100 days of services, this doesn’t guarantee an individual the coverage for the full 100 days. In the event that an individual returns to their baseline or is determined to be at a new baseline, insurance may stop coverage at this point. This process is individual for each person and is communicated through their facility and the insurance company.

In regards to becoming a nursing home resident, this is paid for in a few different ways. First, an individual may pay for these services from the private assets they hold. They would be considered a private pay individual. A second source of financing may be long-term care insurance. This type of insurance is separate from Medicare and is something that has been paid into (similar in concept to life insurance). These policies will pay a stipulated amount which may cover the cost of nursing home services in full or in part. If the policy doesn’t pay the full amount for the services, then an individual would be responsible for the remainder of the balance. A third way an individual may pay for nursing home services is through Medicaid. If an individual qualifies for Medicaid, the Medicaid will reimburse the facility for their services and the individual will be responsible for a patient liability amount determined by Medicaid. This patient liability is typically a majority of one’s social security amount each month minus $50 for the personal needs of the resident.

It is beneficial to talk about and have a plan in the event that you or a loved one may need the services of a nursing home facility in the future. In working with an elder law attorney, financial planner, etc., families can be best prepared for whatever circumstances may present themselves in the future.

82 views0 comments


bottom of page