Who pays for Nursing Home Care?
Most people are confused by the concept of who pays for a stay in a skilled nursing home because the State and Federal governments have a bewildering array of regulations about what constitutes health care and who ought to pay. Unlike hospital stays where a government program may be primarily responsible for payment, such government programs are never primarily responsible for paying for a nursing home stay. We’ve outlined the various payment options that our residents use below.
Private Pay
In this situation the responsibility for a stay in a nursing home is borne by the individual patient, unless a specific exception exists for someone else to pay. The private pay resident is required to pay monthly in advance and a deposit may be required upfront as a condition of admission. We invite you to visit the Hickory Creek Healthcare Foundation nursing home closest to you to determine what private pay rates apply. You will almost certainly find that because we are a tax-free, non-profit, charitable foundation, our rates are less than private pay rates in other nursing homes, especially for-profits, in your area.
Medicaid
Medicaid is a State and Federal program (but administered by each State) that pays for nursing home care, among other things. It is designed for those with limited income with an additional requirement that the applicant must have "spent down" any assets to qualify. Some assets are excluded from Medicaid’s applicant analysis but others are not.
Hickory Creek Healthcare Foundation personnel can assist you or your family member in navigating the Medicaid maze and getting the benefits to which you are entitled. Be aware that there are many misconceptions about applying for Medicaid and there are people who provide false or misleading information. There is no “secret way” to qualify for Medicaid, especially since the Federal and State governments passed stringent new rules about Medicaid fraud and Medicaid exclusions as of January 1, 2008.
We are happy to discuss your individual situation. Please contact the Hickory Creek home in your area.
Medicare Part A
All American citizens or legal residents who reach age 65 qualify for Medicare Part A which covers hospital stays. There is a limited, short-term nursing home benefit under Medicare Part A, provided that a beneficiary had a "qualifying" 3-day hospital stay immediately preceding admission to a nursing home related to the same illness or injury which caused the hospital stay. Medicare Part A can then be responsible for paying for substantially all of the first 20 days of a qualifying nursing home stay, but be aware that some hospitals actually bill for some portion of the first 20 days of benefits so a portion of those first 20 days of benefits may not be available.
As long as skilled nursing services are still required after the first 20 days, there can be additional Medicare Part A coverage for a qualifying nursing home stay for up to an absolute maximum of 80 more days but with substantial limitations and co-payment obligations of around $128.00 per day. For those covered by Medicare Part C (an alternative inclusive Medicare plan that covers Part A, Part B, Part D and Medigap), the plan or policy may pay some or all of this coinsurance amount. After 100 days in a nursing facility in any one benefit period, Medicare no longer pays any of the cost.
For an easy to understand article on who is eligible for Part A, hospital coverage, short-term skilled nursing home coverage, hospice coverage, home care coverage and copayments under Part A, please see: http://www.caring.com/articles/medicare-part-a 
We are happy to discuss your individual situation. Please contact the Hickory Creek home in your area.
Medicare Part B
Medicare Part B is an optional Medicare benefit that covers physicians office visits and can cover therapies, especially, rendered in a nursing home setting. Following a stroke or heart attack or surgery the availability of therapies such as physical, speech and occupational therapies is very important.
All of our nursing homes offer these therapies and we strongly recommend that eligible Medicare beneficiaries apply for and pay for part B benefits. The presence of Part B benefits is beneficial to most residents and there is no penalty or cost to a Medicaid eligible resident who also maintains Part B coverage.
For an easy to understand article on who is eligible for Part B and Part B premium payment information, please see: http://www.caring.com/articles/medicare-part-b
We are happy to discuss your individual situation. Please contact the Hickory Creek home in your area.
Nursing Home/Long-Term Care Insurance
Increasingly, insurance companies sell, or consumers buy, nursing home insurance also known as Long-Term Care Insurance. Many times the insurance is only as good as the company writing the policy and there are often policy limits that are not obvious or even fair. There are wonderful insurance policies out there and there are terrible policies, too. Some companies deny benefits as a matter of course. Other companies pay benefits only after exclusion periods lapse or only after a medical review or some other condition passes.
Our employees are available to assist you in dealing with a nursing home insurance policy, preferably in advance of any nursing home stay. Copies of your nursing home insurance policy and proof of payments will be indispensable. Please do not assume that a nursing home insurance policy will apply to a nursing home stay.
For more information see:
- U.S. government website: http://www.longtermcare.gov or http://www.medicare.gov
Long-term care isn’t covered by Medicare and long-term care coverage also doesn’t replace your Medicare coverage. For more information about long-term care, visit these websites or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. - Indiana government website: http://www.in.gov/fssa/iltcp
Information on long term care insurance plans offered by a partnership between the Indiana government and private companies. - Ohio government website: http://www.ltc4me.ohio.gov
Information on long term care insurance plans offered by a partnership between the Ohio government and private companies.
Quick Links
- Private Pay
- Medicaid
- Medicare Part A
- Medicare Part B
- Nursing Home Insurance
- More Information
