Medicare can pay some nursing facility expenses if you are eligible and several requirements are met. You must go to the nursing home soon after a hospital stay of at least 3 days. The home (including the wing or part where you live) must be certified as a Medicare skilled nursing facility, and you must need that level of care.
Medicare can pay basic expenses for the first 20 days in the nursing home. From day 21 through day 100, Medicare can pay for expenses after you pay a set amount each day (the amount changes every year). Medicare seldom pays any expenses after 100 days in the nursing home.
Medicaid can help pay for nursing facility services if you meet the categorical and financial eligibility requirements. If you are not within the income limits, you might be eligible for Medicaid anyway if your medical expenses are high enough. The Medicaid laws help protect the income and resources of the “at home” spouse of the nursing home resident.
Even if you are not eligible for Medicaid when you enter the nursing home, you may find that your personal resources run out soon, and you need Medicaid. This happens to many people so you may want to consider choosing a nursing home that is certified by Medicaid, in case you later need that program’s help. Our attorneys can assist getting you or your loved one eligible for Medicaid if it looks like nursing home care is imminent. By careful planning, you can help preserve your assets rather than paying them down with nursing home costs.
Some veterans can get help with nursing home expenses from the Veterans Administration. Some children and surviving spouses of veterans can also get this help. To receive these benefits, you must choose a nursing home that is under contract with the Veterans Administration.
Private Health Insurance
Private insurance might pay some nursing home expenses. However, because Medicare pays so little, you should consider buying private insurance that covers long term nursing care. Shop carefully. Some Medicare Supplement policies cover nursing home expenses only after Medicare benefits are exhausted. Yet Medicare law makes it difficult to “use up” your Medicare coverage. As a result, you may be left with a useless insurance policy that never takes effect.