Medicaid and Long-Term Care

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It really doesn’t matter what income bracket you are in, at some point in your life as you age you may face the fact that you need some type of long-term care. tells us that almost 70% of people turning age 65 will need long-term care at some point in their lives.  This really puts things into perspective.  So, when you get to that point, if you ever do, have you thought about how you are going to pay for it?  Many people think that Medicare will pay for nursing home services, it does but only for a limited period of time.  This is how Medicare works:

Medicare Part A covers up to 100 days of “skilled nursing” care per spell of illness.  However, the conditions for obtaining Medicare Coverage of a nursing home stay are quite stringent.  Here are the main requirements:

  • The Medicare recipient must enter the nursing home no more than 30 days after a hospital stay (meaning admission as an inpatient; “observation status” does not count) that itself lasted for at least three days (not counting the day of discharge).
  • The care provided in the nursing home must be for the same condition that caused the hospitalization (or a condition medically related to it).
  • The patient must receive a “skilled” level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered “skilled,” nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. (Few nursing home residents receive this level of care.)

As soon as the nursing facility determines that a patient is no longer receiving a skilled level of care, the Medicare coverage ends.  And, beginning on day 21 of the nursing home stay, there is a significant copayment equal to one-eighth of the initial hospital deductible ($161 a day in 2016).  This copayment will usually be covered by a Medigap insurance policy, provided the patient has one.

After Medicare coverage stops what then?  It will be necessary for you to use your own funds to cover long-term care costs.  If it is not viable for you to remain in your home you very well may end up handing over all of your hard earned money to a nursing home.  Most people that I have spoken to over the years do not even want to think about the fact that they might end up doing this.  So, this is where Medicaid comes into the picture.  Medicaid is a national public health insurance program funded by both the federal government and states and it is operated at the state-level.  Generally most people think that Medicaid provides health and long-term services to low income Americans, to those who are elderly and disabled, and that to qualify people must meet certain income and asset requirements set by the federal government and the state in which a person lives. 

While this is true on the surface and it is what most people working in the aging profession will tell you, conducting further investigation by speaking with Preferred Providers in our network can be very enlightening when it comes to your eligibility for Medicaid.  I highly recommend that you contact us to schedule a free consultation to learn more about your options when it comes to Medicaid and long-term care.  I will tell you this, you do not have to spend down all of your assets to qualify!!  Planning today will help you to avoid making a critical mistake later because looking for options and good decision making rarely take place in crisis mode.  Call us today at (539) 777-2552


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