Medicare does not pay for long-term care. However, it does cover skilled rehabilitation care in a skilled nursing facility, though there are strict rules as to when Medicare will pay for this service.

If the senior in your life needs nursing home placement and you aren’t sure where to turn, it’s important to understand whether Medicare will help.

Medicare and Skilled Nursing Benefit

To qualify for skilled nursing benefit under Medicare, you must have a qualifying inpatient hospital admission of at least three consecutive days (not counting the day of discharge). You must require “reasonable and necessary” skilled services (such as physical therapy) for your diagnosed condition.

You must require skilled care on a daily basis as ordered by a physician, and the services must only be available in an inpatient skilled nursing facility. Medicare pays up to 100 days per benefit period. For more information, visit the Medicare website.

Long-Term Care Insurance

Separate from Medicare insurance, you may purchase long-term care insurance. This insurance covers the cost of living in a nursing home or assisted living facility when you havenot had a qualifying inpatient hospital admission. Without long-term care insurance, you will have to pay for the cost of living in an assisted living facility or nursing home.

Long-term nursing home assistance can be very expensive, depending on your location, your apartment size, and types of services you need. For instance, able-bodied individuals who can use the facilities and dress themselves require less custodial care. Therefore, the daily cost is lower.

Recent figures from the Assisted Living Federation of America indicate the average cost of monthly assisted living care is approximately $3,000. However, rates can reach as high as $6,000 per month.

Fortunately, many states offer Medical Assistance for Long-Term Care. Depending on which state you live in, the program will review your physical abilities to determine the level of care required along with your current financial situation. Medical Assistance may then help offset the cost of care.

If you have an elder loved one who requires long-term care and you’re in the process of determining nursing home placement, I can help evaluate the current living situation and offer options. For more information review my website or contact me directly.

Leave a Comment