What Do Va Long
For extended care services, veterans may be subject to a co-payment of up to $97 per day. The amount of the co-payment depends on the veterans VA health system priority group and individual financial circumstances, and also on the type of care or service provided. The amount of co-payment for extended care services is based on income, and for some services, co-pay amounts are based on the assets held by both the veteran and the veterans spouse.
For extended care services expected to last 180 days or less, the VA looks only at the income of the veteran and spouse, taking into account the veterans expenses. For extended care services expected to last 181 days or longer , the VA looks at the income and the assets of the veteran and spouse. Details of these financial calculations are available from the VAs publication VA Copays and Charges.
Hiring An Independent Nurse For Home Care
Hiring a nurse who doesnt work for an agency could be less expensive for families who are paying out of pocket for in-home nursing care. However, the family takes on all the responsibilities of being the nurses employer with this kind of arrangement. This often includes the tasks listed above.
Read:Hiring In-Home Caregiver Help
Medical Eligibility For Medicaid
While most people who receive Medicaid for long-term care needs are elderly, you do not need to be elderly to qualify for Medicaid assistance with long-term care expenses. Children and adults under 65 may need nursing home care for various reasons. But note that the Medicaid eligibility criteria may be different for these people than for those over 65.
Before Medicaid will pay for a nursing home or other long-term care, the care must be shown to be medically necessary for the patient. States have different rules that determine when long-term care is medically necessary, but usually a doctor must state that this care is needed.
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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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Can The Eligible Person Give Some Of His Or Her Income To A Spouse And/or Children
An eligible person may give some of their income to a legal spouse and/or to children under age 18 living in the eligible persons home. There are limits to how much can be given to the spouse and children. To decide how much can be given, we need income information about the spouse and/or children.
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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.
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.
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Asset Income Levels Differ In Each State
Medicaid eligibility and application procedures vary from state to state.
The federal-state program was established to pay for health care for those who are unable to afford or obtain health insurance, so all states have asset and income limits that govern who can receive coverage, but it’s not one ceiling nationwide.
“Medicaid is often of importance to middle-income Americans because Medicare does not cover the costs of long-term care for illnesses such as Alzheimer’s disease or paralysis caused by a stroke. Most people who need such care for extended periods will eventually deplete their assets and become unable to pay the costs of their care, according to a brochure available online from the National Academy of Elder Law Attorneys .
Medicare Vs Medicaid Roles In Nursing Home Care
Medicare does cover nursing home careup to a point. If you are sent to a skilled nursing facility for care after a three-day inpatient hospital stay, Medicare will pay the full cost for the first 20 days. For the next 100 days, Medicare covers most of the charges, but patients must pay $185.50 per day unless they have a supplemental insurance policy. For day 101 and beyond, the patient pays all costs.
These rules apply to traditional Medicare. People on Medicare Advantage plans likely have different benefits
Some nursing homes wont accept Medicaid patients outright, but the law forbids them from throwing you out if you become dependent on Medicaid when you are in their care.
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Asset Limits For Medicaid Nursing Home Coverage
Unmarried Individuals
To qualify for Medicaid coverage of nursing home care, an unmarried person is allowed only limited assets. These include a maximum of $2,000 in cash, savings, stocks, or other liquid assets a life insurance policy of up to $1,500 face value and a burial plot and burial fund of up to $1,500.
In some states, an unmarried person can also keep his or her home if declaring in writing, upon admission to the nursing home, an intent to return home. However, states that permit this usually put a 6- or 12-month limit on the length of time a resident can keep the home without actually returning to it. If a Medicaid nursing home beneficiary is allowed to keep a house, Medicaid will seek reimbursement from the value of the house when its sold.
Note: Medicaid does not allow asset giveaways.
In determining how much an applicant for nursing home coverage has in assets, Medicaid examines that persons financial records for the five years prior to the application date and penalizes the applicant for any improper transfers made within that five-year period. This is referred to as the look-back period. Find out more on how the look-back period works.
Medicaid has special nursing home coverage eligibility rules when one spouse enters a nursing home and the other spouse remains at home. Medicaid looks at the combined assets of both spouses. From that combined amount, Medicaid allows the community spouse to keep:
Where Can I Find Medicare And Medicaid Skilled Nursing Care Near Me
If you or your loved one are in the hospital and need the services of an SNF, the hospital care team is your first point of contact. Theyll discuss skilled nursing care options and verify the necessary treatment is administered in a nearby Medicare-certified or Medicaid-certified skilled nursing facility.
Quick tip: Medicare enrollees can easily search for Medicare-certified providers and facilities through Medicares Find & Compare search tool.
You can always speak directly to a Medicare or Medicaid representative by calling one of the following numbers.
- Medicaid recipients: Contact your State Medicaid Agency.
- Medicare recipients: Call 1-800-MEDICARE . TTY users call 877-486-2048.
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Need Help With Your Elder
We charge $200 to consult with our elder law attorney where we will:
- Evaluate your elder’s situation
- Translate the issues you are having – there is a great deal of bad information you will receive in helping your elder – we cut through the BS!
- Review the estate plan/durable power of attorney
- Discuss how Medicaid may help your elder’s situation
- In the event you need further help, we will quote a fee for any services
We can help your elder no matter where you live! We have done thousands of Medicaid applications helping families in difficult situations and we are glad to help you.
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Solution 2 Consider Options For Additional Programs While You Are Healthy
If available to you, additional coverage like Medicare Advantage plans for additional health insurance or long-term care insurance products can offset costs throughout your lifetime and help preserve assets.
One possible deterrent to Medicaid is obtaining Long Term Care Insurance. LTC Insurance can be extremely useful to help cover the nursing care facility costs. However, the premiums can be quite steep and it is prudent to be as proactive as possible when looking to obtain LTC insurance because individuals likely will not qualify for long-term care insurance if they already have a debilitating condition.
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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.
Does Medicare Pay For Nursing Homes
If custodial care is all you need, Medicare may not cover it
Medicare offers pretty limited coverage for nursing home care, but it can help offset the costs of a short-term stay or related medical services. If what Medicare offers isnt enough, you have other options, though. Read on to see what Medicare can do for you and what your alternatives are if you need more help.
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Does Medicaid Pay For Memory Care
Though not all communities accept Medicaid, waivers in some states pay for 24-hour dementia care in skilled nursing communities. If a senior chooses to receive care in a memory care community rather than a nursing home, waivers typically dont cover these costs.
For seniors who do choose to receive memory care in a skilled nursing home, waivers usually cover all costs associated with room and board. Under Medicaid policies, seniors must forfeit most of their available income including Social Security checks toward their care and can retain only a small monthly personal allowance. Allowance amounts differ by state but typically are less than $75.
Who Is Eligible For Skilled Nursing
Medicare Part A may cover skilled nursing care on a short-term basis if all of these conditions are met:
- You are enrolled in Medicare Part A and have days remaining to use in your benefit period.
- You have a qualifying three-day inpatient hospital stay.
- Your doctor has determined you need daily skilled nursing care.
- Your skilled nursing care is administered in a Medicare-certified SNF.
Along with the above requirements, you may require skilled nursing coverage for a medical condition thats either:1
- A hospital-related medical condition treated during your qualifying hospital stay, even if it wasnt the reason you were admitted to the hospital.
- A condition that started while you received care in the SNF for a hospital-related medical condition.
Inside tip: Original Medicare is split up into hospital care and medical care. Learn the important details behind why we have Medicare Part A and Part B.
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Whos Eligible For Medicaid
Medicaid recipientsmust meet certain health or physical requirements in addition to income thresholds and asset limitations based on their state of residence and type of coverage requested. Though income requirements vary by state, theyre typically based on earnings beneath 133% of the poverty level. This means if the poverty line in your state is calculated at $13,000, your income would need to be less than $17,290 to qualify for Medicaid.
States can also deem individuals medically needy, meaning they exceed the standard income but have significant medical expenses. Similarly, several states have Medicaid buy-in programs. These allow some individuals with disabilities to have access to Medicaid coverage even if they exceed income requirements.
If your family member is planning to apply for Medicaid, its a good idea to contact your state medical assistance office for more details. Depending on where you live, Medicaid programs may be referred to as auxiliary grant, elderly waiver, or frail elderly waiver programs.
Choosing A Nursing Home
Lifestyle. Think about aspects of your care that are important to you. Can you maintain a lifestyle similar to what you would at home? If you follow a religion, consider whether you can attend or watch worship services.â
Location. You may want to live near family so they can visit easily. If you live in a town with no relatives, consider moving to an area closer to someone in your family.â
Ask for recommendations. Talk to your friends and family about what they think. Chances are, they know other people in nursing homes who can share pros and cons.
Before visiting, call and ask questions over the phone. Make a list of answers for each facility to compare notes easily. Write down any remaining questions you have so you can address them in person or when you call again.â
Visit in person. Make sure you tour facilities when possible. You may not be able to go in person because of visitor restrictions. If this happens, ask for photos and videos of the rooms. Request detailed information about what living and care are like at the nursing home.â
If you can visit in person, make several trips. Visit at least once without announcing. Doing this gives you a better idea of what the facility is like on an average day.â
Show Sources
American Council on Aging: âMedicaid Coverage of Nursing Home Care | When, Where and How Much They Pay.â
Medicaid: âNursing Facilities.â
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Whos Eligible For Medicaid Nursing Home Coverage
Medicaid nursing home coverage is available only to people who are unable to care for themselves at home. They must meet their states eligibility limits regarding income and assets, which differ depending on whether the resident is single or part of a married couple . They may reside in any level nursing home thats certified by Medicaid and that accepts Medicaid payment. Be aware, however, that some nursing homes only accept Medicaid payment for a limited number of residents.
Unlike Medicare coverage of nursing home care, theres no Medicaid requirement of a prior hospital stay, no restriction to skilled nursing facilities, and no requirement that the person need skilled nursing home care or still be recovering from an illness or injury in order for Medicaid to continue coverage. In other words, Medicaid unlike Medicare will cover residence in a nursing home purely to provide help with the nonmedical activities of daily living whats called custodial care.
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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Solution : Review Your Legal And Financial Situation With An Expert
If your familys attorney has expertise working through the intricacies of estate planning, be sure to stay in touch with them and review you or your loved ones portfolio regularly.
If not, you may want to consider enlisting the help of an elder law attorney. As is the case with any specialized area of law, it is prudent to work with an expert in elder law so that the client is being properly advised as to his/her options and planning strategies, says Beisker. It is absolutely critical that clients receive correct advice in regard to the protection of their assets.
