Nursing Homes
Paying for Care
Medicare
Under certain limited conditions, Medicare will pay some nursing
home costs for Medicare beneficiaries who require skilled nursing or
rehabilitation services. To be covered, you must receive the services
from a Medicare certified skilled nursing home after a qualifying
hospital stay. A qualifying hospital stay is the amount of time spent
in a hospital just prior to entering a nursing home. This is at least
three days. To learn more about Medicare payment for skilled
nursing home costs, contact your Medicare Fiscal Intermediary or
the State Health Insurance Assistance Program (SHIP) in your
State. The phone number for the Medicare Fiscal Intermediary or
SHIP office in your area can be found in the Helpful Contacts
section of this website.
Medicaid
Medicaid is a State and Federal program that will pay most nursing
home costs for people with limited income and assets. Eligibility
varies by State. Check your State's requirements to learn if you are
eligible. Medicaid will pay only for nursing home care provided in a
facility certified by the government to provide service to Medicaid
recipients. For more information about Medicaid payments, call the
SHIP for your State or call your State's Medicaid office. The
telephone number is in the blue pages of the phone book.
Personal Resources
About half of all nursing home residents pay nursing home costs out
of their own savings. After these savings and other resources are
spent, many people who stay in nursing homes for long periods
eventually become eligible for Medicaid.
Managed Care Plans
A managed care plan will not help pay for care unless the nursing
home has a contract with the plan. If the home is approved by your
plan, learn if the plan also monitors the home for quality of nursing
care.
Medicare Supplemental Insurance
This is private insurance. It's often called Medigap because it helps
pay for gaps in Medicare coverage such as deductibles and
co-insurances. Most Medigap plans will help pay for skilled nursing
care, but only when that care is covered by Medicare. Some people
use employer group health plans or long-term care insurance to help
cover nursing home costs.
Long-Term Care Insurance
This is a private policy. The benefits and costs of these plans vary
widely. For more information on these plans, contact the National
Association of Insurance Commissioners (NAIC). It represents state
health insurance regulators and has a free publication called "A
Shopper's Guide to Long-Term Care Insurance." You also can get a
copy of the
Guide to Health Insurance for People with Medicare:
by calling 1-800-MEDICARE.
Counseling and Assistance
SHIPs have counselors who might be able to answer your questions
about how to pay for nursing home care, the coverage you may
already have, or whether there are any government programs that
will help with your expenses.
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