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Financial Information
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Financial Information Here is some information on what type of help is available should you select a nursing home as your best solution. Who Pays for Care? Much has been written recently concerning health care costs and cut backs in government entitlement programs such as Medicare and Medicaid. What does this mean for individuals in search of a senior care facility? Individuals are responsible for paying for their own care to the extent that they have the means to do so and are not covered by insurance. Paying with personal funds is known as private pay. Private pay, insurance and the various government programs are outlined below. Private Pay If an individual has assets, he or she is expected to pay with personal funds until the money and assets (other than those funds excluded by law) runs out. A spouse has a legal obligation to pay for nursing home costs unless the ill spouse qualifies for Medicaid. Children and other family members (other than the spouse) are generally not required to pay in most states, but they may choose to in some cases. Some facilities only accept private pay patients. If a facility elects not to participate in the government reimbursement programs (Medicaid and Medicare), they may only accept private pay patients. This is a business decision made by management based on the economics of their facility. For example, if a facility has many amenities that were expensive to construct, and a state's Medicaid reimbursement policy does not allow for adequate cost recovery (i.e., their reimbursement rates are too low), a facility may be forced to only accept private pay patients to meet their budgets. Medicare: Does it Cover the Cost of Nursing Home Care? Medicare covers the cost of a nursing home stay only under certain circumstances. The criteria are as follows:
Even if these criteria are met, Medicare only covers the costs of care for up to 20 days. An additional 80 days may be provided on a co-payment basis. Medicaid: Who is Eligible? Medicaid regulations allow nursing home care to be provided for those that are financially dependent on social welfare programs. Different states have different rules that define "do not have the means." Divesting assets in order to qualify for Medicaid has been a continuing problem for state administrators resulting in regulations that limit the period in which an individual may divest assets prior to entering a care facility. Rules for Medicaid eligibility vary between states. However, the primary qualifications for Medicaid to provide for long-term care in a nursing home include the following:
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