Paying for long term inpatient nursing home care is one of the biggest concerns family members have. Worries about cost can prevent patients and caregivers from looking into much-needed residential treatment. But there are more payment options available than many patients realize. At Evergreen Health and Rehab, our staff helps families find payment solutions that work for them and leverage existing options to get the best possible care at a manageable cost.
Is Inpatient Nursing Home Care Covered By Medicare?
The short answer is yes, if the patient meets skilled criteria. But Medicare coverage is subject to time limits, so families should get all the details before care is needed. Following a hospitalization, Medicare covers 100 percent of inpatient “skilled nursing” costs for the first 20 days at an approved inpatient facility. If a patient needs skilled care after 20 days, Medicare covers costs (including a shared room, meals, therapies and medications) for up to 100 days for eligible patients. Patients should also note that Medicare requires a copayment after the first 20 days of inpatient nursing care. The current copayment is $164.50 per day. After Day 100, the patient is responsible for all costs, unless they have a secondary insurance policy to cover non-paid expenses. These supplemental insurance policies cover copayments not covered by Medicare. These MediGap plans can save thousands when an extended stay is needed.
Medicare is an excellent resource for short term inpatient rehab, including temporary inpatient care after a hospitalization. It’s also an important tool while families make important decisions and explore other options for long-term nursing care.
Does Private Insurance Cover Inpatient Nursing Care?
Most traditional health insurance companies do not include long-term care in their policies, but they will pay if skilled services are needed. Many patients are opting for long-term care coverage that can cover both inpatient and at-home services. Long-term care insurance is a lifesaver for many families, but some older patients and patients who have a serious health condition may not qualify. We advise patients to do plenty of research and talk with a trusted financial advisor before making a decision about a policy.
Does Medicaid Cover Long-Term Care Costs?
In Virginia, Medicaid covers nursing home care for low-income residents and can be available to others under certain circumstances. Many families are not aware that the income limit for long-term care coverage is actually higher than the limit for other Medicaid services–so a senior who doesn’t qualify for Medicaid can qualify for assistance if inpatient nursing care is needed. According to the Virginia Department of Social Services, individuals whose income is less than 300 percent of the Supplemental Security Income figure ($2,205 in 2017) can qualify for assistance with long-term care. People with higher incomes can also qualify if the cost of necessary care is higher than their income, or they have used up other assets to cover long-term care or other medical expenses.
Medicaid covers nursing homes when the state determines inpatient care to be medically necessary, so patients must show that their physical or mental condition requires residential care. Patients must apply through their local social service agency and complete a pre-admission screening.
Understanding what support Medicaid can provide is a lifeline for many middle-income seniors, but there are lots of ins and outs to consider. Our business office can help families determine whether their loved one qualifies.
Help Is Available
Nursing home costs are an important factor in deciding on a long-term care facility. But concern about cost should not keep patients and their families from taking the important first steps to getting the care they need. High-quality facilities like Evergreen Health and Rehab have experienced staff on hand to help families make the best and most informed decisions about their loved ones’ care–including the best way to pay for it. Contact us today to book your free consultation.