Paying for Long-Term Care
Many older adults and caregivers worry about the cost of long-term medical care in a skilled nursing facility. In a word, the costs are quite substantial. These expenses can use up a significant part of monthly income, even for families who thought they had saved enough. How people pay for long-term care depends on their financial situation and the kinds of services they require.
In this segment, we’ll look at a couple of payment sources or options that are often available when paying for long-term care or short-term rehabilitation / therapy services.
Private Pay or Personal Funding: Professional care given in assisted living facilities and continuing care retirement communities is almost always paid for out of pocket. However, it is very different in the skilled nursing setting. Still, many older adults pay for their care with their own money. They may use personal savings, a pension, or other retirement fund, income from stocks and bonds, or proceeds from the sale of property. Although it is not a requirement, other family members or friends may also contribute to this effort. Depending on the amount of personal funding available to the individual receiving care, they may be able to pay for their care privately for as long as it is needed. But there may come a time when all personal funds are exhausted and other payment sources are needed.
Government Programs: Older adults may be eligible for some government healthcare benefits. Caregivers can help by learning more about possible sources of financial help and assisting older adults in applying for aid as appropriate. The Internet can be a helpful tool in this search. Several federal and state programs provide help with healthcare-related costs.
The Centers for Medicare & Medicaid Services (CMS) offers several programs. Over time, the benefits and eligibility requirements of these programs can change, and some benefits differ from State to State. Check with CMS or the individual programs directly for the most recent information.
Medicare: Medicare is a Federal Government health insurance program that pays some medical costs for people age 65 and older, and for all people with late-stage kidney failure. It also pays some medical costs for those who have gotten Social Security Disability Income for 24 months.
Medicare covers the costs of short-term (up to 100 days) rehabilitation and skilled nursing services offered by nursing homes. The basic requirement is that you have a three-day qualifying stay in an acute care setting such as a hospital and that a physician certify that you are in need of such services. Medicare does not cover ongoing, long-term care in a skilled nursing facility.
Here are brief descriptions of what Medicare will pay for:
Medicare Part A:
Hospital costs after you pay a certain amount, called the "deductible"
Short stays in a nursing home for certain kinds of illnesses or therapy services
Hospice care in the last 6 months of life
Medicare Part B:
Part of the costs for doctor's services, outpatient care, and other medical services that Part A does not cover
Some preventive services, such as flu shots and diabetes screening
Medicare Part D:
Some medication costs
If you have a Health Management Organization (HMO) in place of your Medicare benefit, there is usually a different degree of coverage afforded to short-term skilled nursing care and rehabilitation in a nursing home. Most require a clinical pre-certification prior to admission to the facility but do not require a three-day qualifying episode in an acute care setting or hospital.
The important thing to remember is that Medicare or any HMO policy does not cover long-term care. Medicare is only for the short-term rehabilitation and / or skilled nursing services that are often needed after a hospital stay.
Next week we’ll take a look at Medicaid and some other payment resources that will help cover the costs of long-term care in a skilled nursing facility. You can find more information about Medicare benefits at www.medicare.gov, or call 1-800-633-4227, TTY: 1-877-486-2048. You can also call our business office at Mitchell Hollingsworth with any questions you may have at 256-740-5400.