In this Elder Law Minute, Wes Coulson, Illinois and Missouri Elder Law attorney, discusses Medicare and if it pays for nursing home care.
Hi, I am Wes Coulson from Coulson Elder Law, proudly serving clients throughout the St. Louis metropolitan area from our offices in O’Fallon, Illinois and the Westport Plaza area in St. Louis, and this is your Elder Law Minute. Today I want to address a very common question, and that is whether Medicare pays for nursing home care. If I had to give a quick answer, it is don’t count on it all the time and if you do, don’t count on it for very long. Let me explain a little more of what I mean by that.
First of all, Medicare only pays at all if you have had either immediately or just prior to going into the nursing home, a hospital stay in which you were there in-resident and not for observation for at least 72 hours. If it then is going to pay, it pays only if you’re receiving some type of skilled care. The definition is a little bit broader but much more often than not, that means some combination of physical, occupational, and speech therapy. You may have heard Medicare pays for 100 days. Well, that’s a misnomer for a couple reasons.
First of all, 100 days is the maximum. The actual average is closer to around 30 days, and that is because Medicare only pays while you continue to receive that skilled care. The doctor has to prescribe it in relatively short increments, and so it is often cut off with very little notice, and Medicare doesn’t pay everything throughout those 100 days. It only covers the entire cost when it applies for the first 20 days. After that, there is a deductible that for 2019 is a little over $160 a day, and in most cases $160 a day is an awful lot to have to pay out of pocket. If you have a Medicare supplement policy that’s plan (what’s now) F and soon will become G or higher, those pick up that deductible. A lot of other plans, particularly Medicare Advantage, the HMO plans, don’t.
Quick moral of the story – If you’re going into a nursing home, don’t count on Medicare paying for it and don’t wait until you find out with very little notice that now you’re spending your 6, or 7, or $8000 a month out of pocket. The time to plan is way in advance, but if you don’t have that opportunity, get started as soon as you can in the process when nursing home placement becomes apparent.
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