Living In A Nursing Home: Myths and Realities
Myth: Medicare or my health
insurance will pay for a lengthy stay in a nursing facility.
Reality: Because many people mistakenly believe that
Medicare or health insurance will cover their long term care costs,
they are forced to spend down their savings to cover the cost of care.
Consumers should be aware that the government provides little financial
assistance for nursing facility care unless a person is impoverished
and qualifies for Medicaid. Nursing facility coverage falls under
Part A of Medicare and is very limited. If certain stringent conditions
are met, Medicare pays for 100 percent of the first 20 days of care
in a skilled nursing facility (SNF) if that many days are needed.
For the 21st through the 100th days, the patient must share the
cost of care by paying a daily co-insurance rate that changes yearly.
In 2002, the co-insurance payment was just over $101 per day. Medicare
Part B may help pay for covered services received from a doctor
in a SNF, if the person has chosen to participate in the Part B
medical insurance program. If they have used up their Part A coverage
for a spell of illness, Part B also covers a portion of services
received in a SNF, such as physical and occupational therapy.
Under the Part B program, they must pay an annual premium and a
deductible for all Part B services including physician services,
after which Medicare pays 80 percent of the reasonable charges for
covered services.
Long term care insurance offers a more viable solution to accessing
the facility or setting of your choice, paying for it while preserving
personal assets. However, due to lack of public awareness about
long term care and who pays for it, long term care insurance is
used by only five percent of the public.
Financing nursing facility care should be approached with as much
thought and preparation as any major expense. Obtain in writing
what the basic charge will be and understand clearly all financial
arrangements before signing a contract. For more information, see
"Paying
for Long Term Care," and "Understanding
Long Term Care Insurance" in AHCA's Consumer's Guide series.
