As a senior looking towards potential nursing home care, you may wonder: will Medicare cover my nursing home expenses? It's a common question. But the truth is, Medicare's nursing home coverage contains nuances and limitations that surprise many American seniors. As an experienced elder law attorney, I want to provide clarity so you can plan accordingly.
Medicare Part A Explained
First, to understand Medicare's role in nursing home coverage, you need background on Medicare Part A. This covers inpatient hospital stays and provides limited skilled nursing facility coverage tied to qualifying hospitalizations.
You Must Have a 3-Day Inpatient Hospital Stay
To receive any skilled nursing facility benefits from Medicare Part A, you must have a hospital stay lasting at least 3 days right before entering the nursing home. No recent hospitalization, no coverage.
Nursing Home Care Must Be "Medically Necessary"
Additionally, nursing homes must provide daily skilled services like IV medications or physical therapy to meet Medicare's "medical necessity" threshold. This leaves out long-term residential care.
Coverage Lasts 20 Days Max
From there, Medicare Part A will fully cover up to 20 days of nursing home care. This assumes the care is deemed "medically necessary" with daily involvement from nurses, physical therapists, or other medical professionals.
You Pay Copays Up to 100 Days
From days 21-100 in the nursing facility, Medicare Part A covers a portion of costs, but you owe a daily copayment - over $200 per day in 2023.
No Coverage After 100 Days
Perhaps most surprisingly, traditional fee-for-service Medicare offers zero coverage for nursing home care beyond 100 days. And the average length of care for a man is 2.2 years and it is 3.7 years for a woman.
As you can see, relying solely on Medicare to handle nursing home costs leaves dangerous gaps. So what are your options for extended coverage?
Long-Term Support Options Beyond Medicare
While Medicare falls drastically short for extended nursing home needs, several additional options exist:
Long-Term Care Insurance
Long-term care insurance is one option for covering these costs. However, many people find they cannot qualify for it. Other people find that even if they qualify, they either cannot afford it, or cannot afford to keep it as premiums continue to rise to match costs. Even more people discover, often too late, that their policies do not cover everything; leaving gaps.
Medicaid
Medicaid is the number one way the middle class covers these costs. However, Medicaid has strict income and asset limits that must be met before qualifying; this is known as the “spenddown”. The income and asset limits often mean a family is financially wiped out in order to qualify. And, federal law also requires states to attempt to recover any remaining assets after a person passes to reimburse it for benefits paid; this is known as “estate recovery”.
Custom Legal Solutions
Sophisticated asset protection planning using trusts and other tools may shield estates from excessive nursing home costs without sacrificing quality of care. This type of planning is also specifically authorized under federal law. However, the rules are strict and complex. As an experienced estate planning attorney, this solution helps many aging clients breathe easier knowing that they can receive the care they need while protecting their home and retirement nest egg.
Get informed ahead of time on how you can protect hard-earned nest eggs. Call today at our Minnetonka, MN office at (763) 420-5087 or our Florida office at (941) 909-4644 to schedule a consultation. Or, you can fill out the contact form on this page and a member of our team will reach out to you.
If you are not yet ready to schedule a meeting and are looking for additional information, we have a couple of resources for you.
If you would like to learn how to protect your home and life savings from long-term care and nursing home costs, click here to download our FREE guide Save our Home: How to Protect Your Home and Life Savings From Long-Term Care and Nursing Home Costs.
And, if you would like to learn how to make it as easy and inexpensive as possible for your family to manage your affairs during incapacity and after passing, while ensuring your assets only go to whom you want and how you want, click here to register for our FREE online masterclass.
