There are several ways to pay for your stay and care. These include Medicare, Medicaid, long-term care insurance policies, veterans benefits, and private funding. Initially, many nursing home facilities are covered by Medicare, after which your options are long-term care insurance policies, private payment, or Medicaid or a combination of all. You should carefully read the description of all available reimbursements.
Medicare is the federally administered health insurance program for people sixty-five years of age and older, certain disabled people under sixty-five years of age, and people with end-stage renal disease.
What can you expect for Medicare coverage?
–The first 20 days are covered in any Medicare approved skilled nursing facility.
–For the days 21 through 100 Medicare will pay all covered services. The exception to this is a coinsurance that is adjustable annually.
–Semiprivate room rates
–All meals (including special diets)
–Physical, occupational and speech therapies
–Lab and X-ray services
–Some medical supplies and equipment
Conditions and Limitations
–Medicare has strict coverage limitations for skilled nursing facilities.
–Not including the day of discharge, the beneficiary must be in the hospital for 3 continuous days
–An individual must be admitted to the nursing facility within 30 days of their hospital discharge.
–Treatment must be similar nature to that which was treated at the hospital.
–Daily nursing or rehabilitation services are required.
–There must be a determination that only inpatient services will be sufficient.
–In addition to a doctor, specifying daily nursing services. They must also recertify at intervals of 5 days and 14 days after admission. In addition to that the doctor must recertify the need for daily nursing services every 30 days thereafter.
–In addition to Doctor recertification of the need for services. Medicare will also have to review and approve the need for nursing services.
–Lastly, they must be in nursing care for 100 days or less, and Medicare will also have to approve the length of stay. A 100 day stay is not automatically granted under the Medicare system
Participants using the Medicaid service must pay a portion of their nursing care costs with any Social Security benefits they receive
What Is Covered? In most cases, an individual would need assistance with at least two activities and Medicaid would cover all the costs of nursing and medical equipment that a doctor may deem necessary.
In addition, Medicaid will cover the holding of a bed for a for a select amount of time usually one to two-week period if a resident is requiring temporary hospital care.
Also to allow visits with family or friends, and absence of 18 days per year is covered.
Other Financial Sources
Personal or family money
Assets like stocks and savings, plus income from a job or investments.
Pensions and Social Security retirement benefits
The primary income source for many seniors that can cover rent or mortgage payments.
Supplemental Security Income (SSI)
Monthly public assistance checks for seniors and the disabled who have very limited income and assets.
Can be an income source to pay for services to keep a senior in their ownhome, or to pay for nursing home care of a very ill spouse, or even pay forlong-term care insurance.
Sometimes pays only for nursing home care, but some policies cover an array of services in a private home or in an assisted living type of facility.