When Will Medicare Pay for a Nursing Home?
August 13, 2014
By Rick Law of Law Elder Law in Aurora, IL, Serving Seniors and Boomers in the Western Suburbs.
Many people are under the misconception that Medicare will pay for the bulk of their long-term care services. However, nationally, Medicare covers only about 5 percent of all nursing home costs, and the parameters for qualification are many. If you have a condition needing short-term care, such as rehab following a surgery or care following an accident, then there is a chance you may qualify for some skilled nursing facility benefits from Medicare. In order to qualify to receive skilled care in a nursing facility, for example, a patient must meet all of the following criteria:
- Require daily skilled care, which as a practical ma!er, can only be provided in a skilled nursing facility on an inpatient basis.
- Be in the hospital for at least three consecutive days – not including the day of discharge – before entering a skilled nursing facility that is certified by Medicare.
- Be admitted to the skilled nursing facility for the same condition for which the patient was treated in the hospital.
- Generally be admitted to the skilled nursing facility within 30 days of their discharge from the hospital.
- Be certified by a medical professional as needing skilled nursing or skilled rehabilitation services on a daily basis.
If an individual does meet all of the above qualifications to receive payments for a skilled nursing home stay, their benefits will be paid as follows:
- All approved charges for the first 20 days are fully paid by Medicare.
- After day 20, the patient will be responsible for a daily co-insurance amount of $141.50 (in 2011).
If the patient requires more than 100 days of care in the skilled nursing facility, then he or she will be responsible for the entire amount due, beginning on the 100th day. What this means is that essentially, between days 21 and 100, even if a patient qualifies for a Medicare-approved nursing home stay, they are still responsible for paying a daily co-payment of $141.50 (as of 2011).
They will still need to pay $11,320 out-of-pocket ($141.50 x 80 days). And after day 100, they would be responsible for paying 100 percent of the charges due. It is easy to see that even with some coverage by Medicare, the cost of nursing home care can add up quickly.
Too many families needlessly lose everything they have. Don’t let that be you. If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100. Your first consultation is absolutely free. We’ll let you know what steps you need to take, right now, to protect yourself and your family. Call now, because when you’re out of money, you’re out of options!
Rick L. Law, Attorney, Estate Planner
Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine, TheStreet.com, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future. Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.