Paying for Nursing home and other long term care
Nursing home care can be expensive. There are many ways to pay for your nursing home care. Most people who enter nursing homes begin by paying for their care out-of-pocket. As you use your resources (like bank accounts and stocks) over a period of time, you may eventually become eligible for Medicaid.
Medicare
Medicare generally doesn’t cover long-term stays in a nursing home. Even if Medicare doesn’t cover your nursing home care, you’ll still need Medicare for hospital care, doctor services, and medical supplies while you’re in the nursing home.
Medicare Part A (Hospital Insurance) covers skilled care provided in a skilled nursing facility (SNF) under certain conditions for a limited time. Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapies to treat, manage, and observe your condition, and evaluate your care. Medicare covers certain daily skilled care services on a short-term basis (up to 100 days in a benefit period). For more information on Medicare’s coverage of SNF care, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
There are 2 main ways to get your Medicare coverage:
- Original Medicare: Medicare covers very limited and medically necessary skilled nursing care at a nursing home or in your home (with home health care) if you need short-term skilled care for an illness or injury and you meet certain conditions. But Original Medicare doesn’t pay for most nursing home care. For more information on Medicare coverage of skilled nursing facility (SNF) care or home health care, visit Medicare.gov or call 1-800-MEDICARE.
- Medicare Advantage Plans and other Medicare health plans: If you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check with your plan to learn their rules for covering nursing home care. Usually, plans don’t help pay for this care unless the nursing home has a contract with the plan. Ask your plan about nursing home coverage before you make any arrangements to enter a nursing home. If the nursing home has a contract with your plan, ask your plan if they check the home for quality of care.
Prescription drug coverage
If you live in a nursing home or other institution, you’ll get your covered prescriptions from a long-term care pharmacy that works with your plan if:
- You have a Medicare Advantage Plan or other Medicare health plan.
- You have Medicare prescription drug coverage (Part D).
If you have Medicare & live in a nursing home or other institution, you should know:
- If you move in or out of a nursing home or other institution, you can switch Medicare drug plans at that time.
- You can switch Medicare drug plans at any time while you’re living in the institution.
- If you aren’t able to join a drug plan on your own, your authorized representative can enroll you in a plan that meets your needs.
- If you’re in a skilled nursing facility (SNF) and you’re getting Medicare-covered care, your prescriptions generally will be covered by Medicare Part A (Hospital Insurance).
For more information on Medicare prescription drug coverage, visit Medicare.gov.
Medicaid
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Most health care costs are covered if you qualify for both Medicare and Medicaid. Most, but not all, nursing homes accept Medicaid payment. Even if you pay out-of-pocket or with long-term care insurance, you may eventually “spend down” your assets while you’re at the nursing home, so it’s important to know if the nursing home you choose accepts Medicaid.
Medicaid varies from state-to-state. Most often, whether or not you’re eligible for Medicaid is based on your income and personal resources. Many states have higher Medicaid income limits for nursing home residents. You may be eligible for Medicaid coverage in a nursing home even if you haven’t qualified for other Medicaid services in the past.
To get more information on Medicaid eligibility in your state, call your state Medicaid Program. To get the phone number for your State Medical Assistance (Medicaid) Office, visit Medicare.gov/contacts or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Long-term care insurance
This type of insurance policy can help pay for many types of long-term care, including both skilled and non-skilled care. Long-term care insurance can vary widely. Some policies may cover only nursing home care, while others may include coverage for a whole range of services, like adult day care, assisted living, medical equipment, and informal home care.
If you have long-term care insurance, check your policy or call the insurance company to find out if the care you need is covered. If you’re shopping for long-term care insurance, find out which types of long-term care services and facilities the different policies cover. Also, check to see if your coverage could be limited because of a pre-existing condition. Make sure you buy your policy from a reliable company that’s licensed in your state.
Personal resources
You can use your personal money and savings to pay for nursing home care. Some insurance companies let you use your life insurance policy to pay for long-term care. Contact your insurance provider for more information on what your private insurance covers.
