Does Health Insurance Cover Nursing Homes?
If you are suffering from a chronic or debilitating illness, you might be looking at moving into a nursing home to get the required care and assistance. However, nursing homes can be prohibitively expensive for many people. According to AARP, the average cost of a nursing home is $50,000 a year and rising.
Most traditional health insurance plans do not cover nursing homes. You are required to purchase private long-term insurance to pay for nursing home stays. Since the terms and conditions vary vastly depending on individual long-term insurance plans, you should examine your policy very carefully.
Other options for paying for nursing homes come via Medicare, Medicaid, and private sources. It is best to seek out all your options and have contingency plans in place, just in case you get a sudden need for nursing home care.
What is long-term care?
As an increasing number of elderly Americans seek healthcare assistance, long-term care has evolved to provide an umbrella of services.
Long-term care is defined as the provision of a range of services that meet the medical, personal, and social needs of chronically ill or disabled patients. Such services are best provided in 24-hour nursing care facilities.
What kind of care do nursing homes provide?
Nursing homes act like a home away from home for sick and disabled patients. They are support institutions that offer a range of services and provide comprehensive care. Besides medical monitoring and treatment, nursing home patients are helped with daily functions such as bathing, eating, getting dressed, and exercise.
A good nursing home is staffed by a range of qualified and properly certified professionals such as registered nurses, physical and occupational therapists, and on-site doctors, among others.
While services vary from institution to institution, most nursing homes provide patients with room and board, medication monitoring, custodial assistance, emergency care, and recreational activities.
How can I pay for nursing home care?
Nursing home care is expensive and can be a huge financial drain on patients. Indeed, unfortunate stories of bankruptcy and financial loss occurring because of nursing home bills abound.
But careful planning and research can help alleviate, and even prevent such a catastrophic financial drain.
As you research your nursing home options, remember to ask the administrative staff about the accepted payment options for their particular facility.
The most common option for nursing care payment for Americans above the age of 65 is Medicare, a federal health insurance program. The benefits of Medicare include any major hospital care and 100 days of nursing care.
However, Medicare coverage is allowed only if the patient needs skilled medical care. If the patient requires personal care such as bathing, getting dressed, etc., but not medical assistance, then Medicare will not pay for such care. Additionally, make sure that the nursing facility you are considering has a Medicare license; otherwise, you will not be covered.
Medicaid is another option for nursing care coverage. Medicaid is a joint insurance program between the federal and state governments that provides medical coverage for low-income Americans.
Getting coverage under Medicaid can be an exhausting and confusing procedure since terms and conditions vary widely depending on the state of residence. In most cases, coverage under Medicaid requires you to run through all of your personal assets, which means you need to pay a certain amount out-of-pocket before Medicaid kicks in.
Given the complexity of Medicaid, it might be advisable to get legal assistance to determine Medicaid eligibility.
Another option is getting private long-term care insurance. This usually supplements Medicare coverage. As you research your private care options, make sure you double check all the conditions. Long-term care insurance policies vary greatly depending on the health insurance company. Every policy has different eligibility needs, costs, benefits, and strong restrictions.
What should I look for in a nursing home?
Horror stories about mismanaged nursing homes, unprofessional and abusive behavior towards patients, and outright malpractice are regular news fodder. So it is imperative that you ask the right questions and keep a vigilant eye as you seek long-term nursing home facilities for yourself or a loved one.
Good nursing homes can have a long waiting list. So start looking at your options as early as possible. It is important that you create a checklist of needs as you seek a nursing home.
The most important question is about the kind of care that the facility provides. It should meet your list of needs, which should include the services you essentially require such as medical monitoring, personal care, recreational needs, and more.
It is very important that the medical facility you choose have the right local and state licenses. Make sure that all the caregivers hold the right certification and geriatric training.
Another important marker is the financial aspect. It is important that you know about the facility’s Medicare license, payment options, and plans. Make sure you understand the billing, credit, and payment policies. Ask for a clear fee structure to avoid any unpleasant surprises later.
It is also suggested that you walk around the nursing home facility to ascertain whether you like the layout, design, and services provided. If you require a wheelchair, make sure there is ample access.
Since you are likely to spend a substantial amount of time in such a facility, do not hesitate to ask any questions, no matter how trivial they might seem.