Some Assets Don’t Count
Medicaid eligibility is based on a person’s monthly income, which may include a pension, Social Security and other payments, plus countable assets.
Assets that don’t count in the eligibility equation include a home if used as your primary residence, a car and some types of trusts. In other words, if you still live at home but your spouse needs regular custodial care, states will not include your house and car in their estimate of assets.
Planning with an elder law attorney can help with the rest.
“Elder law attorneys can help you look at how much you have now, and how much you can have to qualify for Medicaid, and help you figure out how to get from point A to point B, NAELA President Jennifer VanderVeen says. Particularly with regard to couples, it makes no sense for one spouse to become impoverished when there are planning techniques available to protect assets and allow the spouse to keep more assets than the basic guidelines allow for.”
Do All Nursing Homes Accept Medicaid
A majority of nursing homes accept Medicaid however, this is also largely dependent on the state you reside in. To avoid complications with payment and coverage, Id recommend checking with your nursing home facility to see if they are a Medicaid-certified nursing facility. If it is, then you should be eligible for coverage under the Medicaid skilled nursing facility.
In the event that you find out the nursing home is not Medicaid-certified, you would have to transfer to a nursing facility thats covered by Medicaid.
Medicaid Nursing Home Benefits
Medicaid pays 100% of nursing home costs in most cases if you meet eligibility requirements. In most states, the monthly income limit is $2,382 for individuals or $4,764 for spouses. Your countable resources must be less than $2,500. Income and resources that count toward the limit include:
- Life insuranceâ
âIn most states, Medicaid looks at your income over the last 5 years. Any assets you transferred out of your possession within that time may still count toward your income. Do not try to transfer financial assets in order to qualify for Medicaid.ââ
You may be penalized for violating Medicaid rules. This can result in having to pay for your nursing home care out-of-pocket until you meet eligibility requirements.ââ
Keep in mind that eligibility is on a rolling basis. It is possible to make as little as $1 over the monthly income limit and not qualify for the entire month. If this happens, you may have to pay for your nursing home care and related expenses yourself.ââ
Types of nursing home coverage. You have three nursing home options with Medicaid:
- Skilled nursing â care related to medical issues and related services
- Rehabilitation â staying in a facility short-term following an illness, injury, or surgery â
- Long-term care â around-the-clock care at a facility because of a mental or physical condition â
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Using Private Insurance To Cover Nursing Home Care
Many Americans use long-term care insurance to cover nursing home fees and other personal care costs in their elder years. Long-term care insurance is designed to lower out-of-pocket expenses for stays in a broad range of care settings, including nursing homes and assisted living facilities. Its best to buy a long-term care insurance policy well before the need to use it is likely to arise, even if this means paying premiums for many years. Premium rates are much lower for people who are in good health when they purchase their policy.
If your loved one has a life insurance policy, cashing it out can help him or her pay for nursing home costs, and certain types of life insurance will allow the policyholder to use it as long-term care insurance. If a life insurance policy includes accelerated death benefits, policyholders are able to take a portion of their death benefit while theyre still alive in order to pay for long-term care. In cases where the death benefit is not enough to cover nursing home costs, the policyholder might choose a life settlement, in which he or she sells the life insurance policy to a third party.
Today, there are also a number of combination life insurance policies that include long-term care benefits, although these policies tend to be pricier than standard life insurance.
Home Care Waiver Programs
Pennsylvania also operates several Medicaid Waiver programs that provide home health care services to low-income Pennsylvanians.
To qualify for any of Pennsylvanias Waiver programs, you must meet the nursing home level of care. In addition, you must have income less than $2,163/month and fewer than $8,000 in resources. To apply for waiver programs, contact the Office of Long-Term Living Helpline at 866-286-3636.
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When A State Can Recoup Benefits
After the Medicaid recipient dies, the state can try to recoup whatever benefits it has paid out. The home is usually the only major claimable asset. Currently, the state can only put a lien on it if it is part of the deceased’s probate estate. If the asset is jointly owned with a spouse or in a life estate or trust, then it can escape recovery.
In most states, the government can place a lien on the home after the death of both spouses, unless a dependent child resides on the property.
Paying For A Nursing Home With Medicaid
Your Medicaid policy pays a fixed daily rate to nursing homes, so you owe nothing out of pocket. Items covered by this daily rate include:
- Cost of nursing care
- Gifts for self or others
- Flowers or plantsâ
- Outside social eventsâ
âThe tradeoff is that you must give up most of your income to Medicaid. As a nursing home resident, Medicaid allows a $130 a month stipend. You pay your state your monthly income minus the $130 stipend each month. For example, if you make $1,500 per month, you pay your state $1,370 and keep $130.ââ
If you have to pay out-of-pocket deductibles for doctor and hospital visits, you can deduct them from your monthly income. This empowers you to pay for long-term care. You pay the state less based on your monthly medical expenses.ââ
New Medicaid eligibility. Many times, people move to a nursing home and exhaust their income paying for care. After using your assets, you may be eligible for Medicaid regardless of past denial. If you already live in a nursing home but it is not Medicaid certified, you may have to move. Medicaid only pays for certain nursing home facilities.ââ
Before making any Medicaid nursing home decisions, talk to an attorney. If you own your home, Medicaid may count that as an asset to use for nursing home payment. When you pass away, Medicaid may have rights to claim the property to cover part of your long-term care expenses.â
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How Can I Pay For Nursing Home Care
Medicare generally doesn’t cover
stays in a nursing home. Even if Medicare doesnt cover your nursing home care, youll still need Medicare for hospital care, doctor services, and medical supplies while youre in the nursing home. Find out what nursing home care Medicare does cover, and how Medicare prescription drug coverage works if you live in a nursing home or other institution.
Most people who enter nursing homes start by paying for their care out-of-pocket.
There are several other ways you can pay for nursing home care:
Ask Questions About Home Nursing Care In Phoenixville Today
At Personal Health Care, we are committed to providing exceptional home health care services to children and adults. If you have questions about Medicaid and nursing home care coverage, we can help you get answers or put you in touch with someone who can. To schedule a free in-home health care assessment, please do not hesitate to call us today at 933-6130. Based in Phoenixville, we serve communities all over Southeastern Pennsylvania.
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How Much Will Medicaid Pay For Nursing Home Care
For qualifying individuals, Medicaid picks up most of the tab for nursing home care, paying an average of 45 percent to 65 percent. However, coverage is largely dependent on a variety of factors such as financial status, the state you reside in, and the level of care needed.
Medicaid coverage amounts may vary from state to state, depending on the demand for nursing home care coverage. For example, the average cost of nursing home care in the state of California is on the higher end at $304 a day, compared to Texas at $165. This greatly impacts the coverage and benefits you can receive from Medicaid to offset the costs of nursing home care.
Nursing Home Average Costs
On average, a nursing home costs $225 daily for a semi-private room and $253 for a private room. Monthly charges range from $6,844 to $7,698 for semi-private and private rooms respectively. Annual costs range from $82,128 to $92,376 for full time nursing home care. Additional costs may be incurred if dementia, memory care or other special services are required.
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Medicare Coverage Of Nursing Home Care
One of the biggest misconceptions about Medicare is that it provides long-term nursing home coverage. It doesnt.
Medicare covers only limited periods of inpatient care, only in a skilled nursing or rehabilitation facility following a hospital stay, and only under strict guidelines. Still, Medicare nursing home coverage can be vital if the person youre caring for has just been hospitalized. Medicare can pay for costly short-term, intensive rehabilitation, which in turn can give you a chance to arrange for longer-term care if its needed.
Does Medicaid Cover Nursing Homes
Medicaid covers nursing home costs if you qualify. Medicaid is the largest fund-source for nursing home care. For those who are eligible, Medicaid covers long-term nursing home care in Medicaid-certified facilities4 when medically necessary. You’ll have to be under a certain income level and meet other state-specific requirements to qualify.5
All 50 states offer Medicaid, but nursing home services, cost coverage, and eligibility requirements vary widely by state. For example, each state sets its own income limit to determine if you are eligible for Medicaid. Not all nursing homes accept Medicaid, so check with each facility.
Unlike Medicare, Medicaid does not impose an official time limit on nursing home stays as long as they’re in a licensed and certified Medicaid nursing facility.
What Is Covered by Medicaid
- Long-term care covers nursing home stays for qualifying patients needing ongoing care for a chronic mental or physical condition.
- Skilled nursing and related medical care.
- Rehabilitation from illness, injury, or disability.
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How Does Someone Qualify For Nursing Home Coverage With Medicare
In order for someone to receive nursing home coverage under Medicare, a number of different conditions have to be met:
- Prior hospital stay: A patients stay in a skilled nursing or rehabilitation facility has to begin within 30 days of an inpatient hospital stay of at least three days .
- Need for daily skilled nursing or rehabilitation: Medicare provides nursing home coverage only if the patient needs and his or her physician prescribes daily skilled nursing care or physical rehabilitation. For someone who needs skilled care but doesnt need it every day, Medicare wont cover nursing home care. However, in that situation Medicare might cover home care.
- Medicare-approved facility: For Medicare to cover inpatient skilled nursing or rehabilitation care, the care must be received in a facility that Medicare has certified for that purpose.
- Improving condition: Medicare covers nursing home care only as long as the patients condition is improving. Once Medicare, the patients doctor and the facility have determined that his or her condition has stabilized, Medicare will no longer cover inpatient nursing home care.
Does Medicare Cover Nursing Homes And Long
Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. Medicare Part A does cover care provided in a skilled nursing facility .
If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. You may need to exhaust your personal resources on medical care before you are eligible.
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With 3 Solutions For Protecting Yourself And Your Family
Are you unsure about the difference between Medicare and Medicaid? If so, you are certainly not alone. The two programs are commonly confused, which can lead to uncertainty, particularly when coordinating long-term care services.
Medicare and Medicaid are similar in that both are government programs offering health care coverage to those who qualify. This however is where the similarities end. Qualifying criteria and enrollment processes between the two programs are also very different. Medicare and Medicaid are even funded by different sources.
If you find yourself navigating the long-term care system for the first time on behalf of yourself or a family member or client, sorting through what Medicare and Medicaid does and does not cover could prove to be a challenge. Being aware of these misconceptions about Medicare, Medicaid, and what they do and do not cover can better prepare you to keep it all straight.
Dual Eligibility For Medicare And Medicaid
Finally, keep in mind that it is possible to qualify for and be covered by both Medicare and Medicaid simultaneously. Such individuals are known as dually eligible beneficiaries. With dual eligibility, Medicare pays for covered medical services first and Medicaid is considered the payer of last resort. For example, Medicare covers qualifying health care costs for doctors appointments, durable medical equipment and hospitalizations while Medicaid covers qualifying remaining expenses, such as Medicare premiums and cost-sharing requirements and long-term care services.
Keep in mind that coverage and benefits available for dually eligible beneficiaries vary by state. To learn more, read Dual-Eligible Beneficiaries: Some Seniors Qualify for Both Medicare and Medicaid.
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V Frequently Asked Questions
How much does home health care cost?
Home health care costs an average of $26 per month in the United States. This comes out to $4,160 per month for 40 hours of care per week. Basic in-home care like companion care and personal care assistance is slightly less expensive than home health care, at an average of $25 an hour or $4,074 per month.
What is home care versus home health care?
Home care is a type of senior care in which aides provide personal care assistance and companion care, versus home health care which involves skilled medical care. The fundamental difference between home care and home health care is the medical component companion and personal care aides are not certified to provide any medical services, while home health aides undergo more medical training.
Is home care cheaper than a nursing home?
Home care is sometimes cheaper than a nursing home. Which type of care costs more will depend on how much care you need and the financial assistance options available to you. For example, if you just need a few hours of home care per week, it will be less expensive than a nursing home. However, for 24/7 care, a nursing home is less expensive, especially when taking Medicaid and Medicare assistance into account.
Will Medicaid pay for in-home care?
Does Medicare pay for home care?
How Can I Find A Medicare
You can call Medicare to find out about Medicare-certified skilled nursing facilities in your area. Call Medicare at 1-800-MEDICARE and speak with a counselor they answer the phones 24 hours a day, seven days a week, except on certain federal holidays. Or you can visit Medicares web site at Medicare.gov to search and compare skilled nursing facilities. At this web site you may also want to read the guide to choosing a nursing home and/or the checklist of questions to ask when you are visiting skilled nursing facilities.
Can I help you further with your questions about skilled nursing facilities or your options when it comes to Medicare coverage? You can use the links below to schedule a phone appointment or have me email personalized information to you. If you would like to compare plans on your own, you can use the Compare Plans or Find Plans buttons on this page.
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Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.
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How Much Will I Pay For Home Health Care With Medicare
For the home health services they cover, Medicare coverage is quite complete. You will pay nothing out of pocket for covered home health care services.
However, you may require durable medical equipment as part of your care. This includes, but is not limited to, such items as:
- Blood sugar monitor
Under Original Medicare, you will pay 20 percent of the full cost for any durable medical equipment you need. If you have Medicare Advantage or a Medigap plan, contact your plan providers for details.
Pro Tip: Deciding between assisted living or home care? Our experts have taken a deep dive into the difference between assisted living and home care so you can decide what is best for you or your loved one.
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Nursing Home Diversion Programs
Most states have non-Medicaid funded programs that provide care services and supports to individuals who require nursing home level care but are not eligible for Medicaid. As with Medicaid waivers, these programs provide services to beneficiaries in their homes or communities with the specific goal of preventing nursing home placement, as the cost to support an individual full-time in a nursing home greatly exceeds that to provide assistance at home. Recognizing that much of the burden of caregiving is shifted to family members, nursing home diversion programs often offer support services to the family caregivers, as well as services to the individual in need of care. Support like respite care to relieve the family caregiver, transportation assistance, and home delivered meals serve the objective of unburdening family members.
Nursing home diversion programs is a loose categorization. These programs typically do not refer to themselves using that name. Rather, each program in each state has its own name. Some states offer more than one program targeting different groups of seniors and other states offer no programs. The types of services available are centered around helping an individual remain living at home. Therefore home care, respite care, transportation assistance and chore services are usually included, but the complete list of services is broader and specific to each program. A state by state list of programs is available here.
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