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MEDICARE
Medicare is national health insurance for the elderly and permanently disabled. There are four parts to Medicare:
Part A – covers inpatient hospital expenses, rehabilitation and skilled nursing in Medicare Certified Rehabilitation Hospital or Skilled Nursing Facility. There are deductibles and co-payment requirements. However, Part A does not pay for “custodial/non-acute or rehabilitation” stays in licensed nursing facilities.
Part B – covers outpatient testing, physician services, etc. It is an option under Medicare, but most people choose to pay for it. It may provided some coverage for physician services in a long term care facility.
Part C – this is an option that Medicare beneficiaries can choose. Private insurance companies offer this as a Health Maintenance Organization (HMO) option. It can be a good plan if the person is relatively well and does not require long term care.
Part D – provides coverage for the purchase of medications. There are many options available. It definitely saves money but is complex to understand. However, when a person enters a licensed nursing facility they may have to switch to a plan that the particular nursing home works with.
The most important thing to remember is that Medicare will NOT pay for most long term nursing facility care. It will cover costs if your loved one is sent to the hospital, and for short term rehabilitation following a hospitalization (usually 21 days or less).
PRIVATE PAY/LONG TERM CARE INSURANCE:
Because most nursing facility stays are considered “custodial care” (meaning no active treatment is being made with a goal of curing a disease or condition), Medicare will not pay for most nursing home stays.
That means that families typically have to pay out of pocket for nursing services. (If the loved one is low income, they may qualify for Medicaid, a welfare program. See below). This leaves two options.
Admission Agreements/Contracts to Pay Privately for Care:
The resident and/or family members will be required to sign an admission agreement that includes both an upfront deposit (at least a minimum of one month’s stay) plus a requirement that someone be the responsible party (i.e. they are responsible for paying the bill and can be sued for breach of contract if they do not pay). Most facilities will not allow your loved one who is now the resident in the home to be the only responsible party, however family members may NOT be held financially responsible for their loved on e and do not have to sign paper work stating that they are. (This also is a time where it is important for someone, be it family or friend, to be appointed the Durable Power of Attorney for the loved one. That way they can access the loved ones funds and use them to cover the cost of care)
LONG TERM CARE INSURANCE POLICIES
These policies can provide a means to cover some of the costs of care. However, remember that all long term care insurance plans are not the same. Keep a copy of the policy in a safe place and review it to understand exactly what it does (and does not cover).
Some older plans require a hospitalization of three days or more before your loved one is covered in a nursing facility. The amount paid per day can vary widely depending on the plan. Most plans will not cover the complete cost of care. Many plans have a limit on either the number of days covered or the amount that can be paid out for nursing facility care. Either way, however, long term care insurance can be a great help in covering the cost of care.
MEDICAID:
The most frequent question asked by family members who are arranging long term care for their loved one is, “What do we do when she/he runs out of money?” In this case, your loved one may be eligible for Medicaid (aid on the end, meaning a welfare program). Unlike Medicare, Medicaid will pay all expenses for skilled nursing home care indefinitely for qualified persons (though their monthly income, less $30.00 for personal items, must be paid to the nursing home also; Medicaid pays the difference between the person’s income and the total bill each month). The loved one must be in a Medicaid certified Vendor bed. The Medicaid Program is administered by the Missouri State Family Support Division (FSD).
Where do I go to apply for Medicaid?
As soon as your loved one is residing in a Medicaid Certified Vendor Bed (either going directly there from the hospital or their home, or having moved from a private pay bed to a Medicaid bed), you need to apply in person at the Family Support Division office in the county where the nursing home is located (not where your loved one’s house or apartment is). Here is the list of Family Support Offices in the region that we serve.
MISSOURI VETERANS ADMINISTRATION (VA) BENEFITS:
This often overlooked source of aid is available by filling out an application for VA medical services. All veterans are entitled to apply for residence at one of the state veterans homes. Often there is a waiting list for admission. The length of the wait will depend on the individual’s condition and the priority category assigned to him/her.
Aid and Attendance payments are available to veterans and their spouses who are over 65 and suffering from a disability requiring nursing care. The veteran must have served during “war time” as defined by the VA. There is also an income test.
**For further information and requirements on financing care, please contact us by email, or by telephone at 314-918-8222**