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Common myths about nursing homes: Will Medicare pay for everything?

May 25, 2011

Myth: “I don’t need to worry about paying for a nursing home (rehab/skilled care center) stay, Medicare will pay for everything.”

Explanation: Medicare only pays 100 percent for the first 20 days of a nursing home stay. For days 21 through 100, Medicare pays all but $141.50 per day. Medicare only pays for a nursing home stay if the beneficiary has had a three-night stay as an inpatient in a hospital within 30 days of being admitted to the nursing home and the beneficiary requires skilled care, as defined by Medicare. Medicare coverage ends as soon as the beneficiary no longer requires skilled care.  

Medicare coverage is limited and dependent on several variables. The bottom line is that you cannot depend on Medicare to cover your nursing home expenses. In fact, I would suggest that the best approach is to assume that Medicare will not be paying a dime.

Medicaid is a government program that pays medical costs for persons with limited income and limited assets. Medicaid will assist in paying nursing home costs once a beneficiary qualifies for the benefit. In order to be eligible for Medicaid, your income and assets must be below the amount that is set by your state of residence. If you are interested in finding out more about Medicaid, you can visit your local Medical Assistance office or do an Internet search for “Medical Assistance” plus the name of the state in which you live.

A third option for paying for nursing home care is to pay all expenses out of pocket. This can be very costly. The average annual cost for a nursing home stay can be well over $60,000, depending on location.

Another option is to purchase long-term care insurance. Insurance can help soften the blow of the nursing home bill. Visit with an insurance agent to determine policy options and costs.

While the cost of a nursing home stay can be financially draining, planning ahead can help to ease the burden. But keep in mind that you may be caught off guard if you think that Medicare will pay for all the costs of nursing home care.

By Mary Jo Ball, MSW
Manager, Resident Services
Click here to contact Mary Jo

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