Paying for Long-Term Care
Know your options
Most people are confused by the concept of who pays for a stay in a long-term skilled nursing center. Medicare or Medicaid may pay for a hospital stay but are never the primary payment resource for long-term care. We’ve outlined the most common payment options below. Each of our healthcare administrators is happy to discuss your specific needs and circumstances.
Visit the Hickory Creek location nearest you to learn our rates and receive help understanding the any of the options below. As a tax-free, non-profit, charitable foundation, our rates are typically less than other homes in the area.
In this situation the responsibility for a stay in a skilled nursing center 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.
Medicaid is a State and Federal program (administered by each State) that pays for long-term, skilled 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. It also requires the resident or responsible party to file an application and provide appropriate supporting documents to receive approval to participate in the program.
Medicare Part A
All American citizens or legal residents who reach age 65 qualify for Medicare Part A. There is a limited, short-term skilled nursing benefit under Medicare Part A, provided that a beneficiary had a "qualifying" 3-day hospital stay immediately preceding admission to a skilled nursing center related to the same illness or injury which caused the hospital stay. In that case, Medicare Part A is responsible for paying for substantially all of the first 20 days of a qualifying skilled nursing stay. Be aware that some hospitals bill a portion of the first 20 days of benefits reducing the funds available for the skilled nursing center.
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 skilled nursing stay for up to an absolute maximum of 80 additional days but with substantial limitations and co-payment obligations of around $164.50 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 skilled nursing center in any one benefit period, Medicare no longer pays any of the cost.
Understanding Medicare Part A: an article that may help you further understand the coverage and payment options.
Medicare Part B
Medicare Part B is an optional Medicare benefit that covers physician office visits and can cover therapies rendered in a skilled nursing center. Following a stroke, heart attack, or surgery physical, speech and occupational therapies are often prescribed and covered by Medicare Part B. 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.
Understanding Medicare Part B: an article that may help you further understand the coverage and payment options.
Skilled nursing center/long-term care insurance
Long-Term Care or Skilled Nursing Center Insurance can be a valuable asset - but not always. Each policy is different and should be reviewed carefully in advance of needing long-term care.