Individuals who have a qualifying health care plan under the Affordable Care Act often wonder if their insurance covers the cost of care at a nursing home. Unfortunately, many common insurance plans do not cover nursing homes and those costs must be paid from other sources.
However, Medicaid may be able to offer some financial assistance in paying nursing home costs. There are, however, certain qualification standards in place. Some individuals who didn’t qualify for Medicaid benefits in the past may be eligible once they enter a facility that accepts Medicaid payments.
Typically, nursing home costs are made out-of-pocket until Medicaid kicks in after a set period of paying these expenses, but only if you qualify for assistance. Even then, Medicaid is limited in what it covers with respect to nursing home expenditures.
For instance, Medicaid isn’t eligible for use for room and board costs and many such facilities won’t accept payments made through Medicaid in the first place. It’s important to determine if the facility you are considering for yourself or a loved one will accept Medicaid before you apply to move in.
Since most insurance plans do not cover nursing home costs, individuals are expected to make those payments out of their own resources of personal wealth. This can include monies kept in checking or savings accounts or investments that are liquidated and used as payment. You may also find nursing homes that let you make payments from a life insurance policy, if that policy allows for money to be withdrawn and used for medical costs.
For those who qualify, Medicaid can be of valuable assistance in defraying some of the costs that come with a stay in a nursing home. Medicaid assistance may not be available until a certain amount of money has been paid out of pocket, and only then will an individual be eligible to receive those benefits.
If a nursing care facility accepts Medicaid payments (and not all such facilities do), some homes will place a patient in a Medicaid-certified section. This is where those individuals who are eligible for benefits are located within that facility.
For those who do qualify for Medicaid assistance, there will still be some out-of-pocket expenses needed to pay for nursing home care. These costs are determined by income and any qualifying deductions that are applied. The balance due after those expenses are paid will be billed directly to Medicaid.
Medicaid Assistance Requirements
In order to allow you to qualify for Medicaid, you will be expected to lower your current assets. There are specific rules and regulations as to what counts as an asset and what does not. There are additional rules in place among the states that permit married couples from keeping some of their assets protected if one of the partners has been put into a medical facility or care institution such as a nursing home. That spouse may hold on to up to half of the joint assets of the couple at up to $119,220 along with a monthly income allowance for the year 2016.
Applying for Medicaid is easy to do. Contact your local office to ask them about qualifying for any of their programs including All-Inclusive Care for the Elderly program and Medicaid nursing home benefits. They also offer many home and community-based waiver initiatives.
Current federal statutes are in place to protect the spouse of a nursing home resident from going bankrupt just to pay care costs for their partner. Applying for Medicaid as a couple where one member enters a nursing care facility will make the other member subject to eligibility under certain “spousal impoverishment” rules.
These laws are in place to keep the spouse who is living at home with enough assets so that they are not left destitute and they are able to cover all essential living expenses. The assets include current resources in bank accounts and other investments, along with a portion of the income of the nursing home resident.
Qualifying for Medicaid through the reduction of assets can lead some applicants to transfer their assets to another party. However, making a transfer for less than the current fair market value may trigger a penalty where Medicaid doesn’t payout on your nursing care costs for a period of time. This will often depend on the worth of the assets that were transferred.
If you give away assets and face a penalty, you may be eligible for an exception, particularly if a spouse or a blind or disabled child is in the picture. Gifting your assets to someone else will typically mean Medicaid won’t pay for nursing home care over a course of months or perhaps years.
Keeping Your Home
If a Medicaid recipient is in nursing care, their home is safe from any liens or possession, particularly if there are family members living inside of it. Nor can the home be claimed to cover any outstanding costs while care is being administered. Should the recipient pass away while in a nursing care facility, then Medicaid may try to recover the benefits that were paid out from the estate, not by seizure of the home.
Long-Term Care Insurance Options
Though most insurance plans don’t cover nursing home costs, there are options for purchasing long-term care insurance coverage that can assist in taking care of such expenses. These plans cover the costs of long-term nursing home care involving skilled and non-skilled care alike. Depending on the depth of coverage purchased, your policy can take care of expenses for nursing home care as well as more comprehensive services such as casual in-home care, assisted living services, adult day care, and medical equipment.
Before you decide on any type of long-term care or assisted living service, be sure to get in touch with your provider if you already have this type of insurance and find out what extent of services are included in your policy. If you do not yet own long-term coverage, be sure to check into all of the possible plans that can handle you or your loved one’s specific needs for care before you apply.