Living In A Nursing Home: Myths and Realities
Advice For Families

Myth: Medicare or my health insurance will pay for a lengthy stay in a nursing facility.

Reality:

Because many people mistakenly believe that Medicare or health insurance will cover their long term care costs, they are forced to spend down their savings to cover the cost of care.

Consumers should be aware that the government provides little financial assistance for nursing facility care unless a person is impoverished and qualifies for Medicaid. Nursing facility coverage falls under Part A of Medicare and is very limited. If certain stringent conditions are met, Medicare pays for 100 percent of the first 20 days of care in a skilled nursing facility (SNF) if that many days are needed. For the 21st through the 100th days, the patient must share the cost of care by paying a daily co-insurance rate that change yearly. In 2010, the co-insurance payment was just over $140 per day. Medicare Part B may help pay for covered services received from a doctor in a SNF, if the person has chosen to participate in the Part B medical insurance program. If they have used up their Part A coverage for a spell of illness, Part B also covers a portion of services received in a SNF, such as physical and occupational therapy. Under the Part B program, they must pay an annual premium and a deductible for all Part B services including physician services, after which Medicare pays 80 percent of the reasonable charges for covered services.

Under the Part D program, Medicare can help seniors with the cost of prescription drugs. To learn more about Medicare Part D, visit Medicare online at www.medicare.gov or call 1-800-633-4227.

Long term care insurance offers a viable solution to accessing the facility or setting of your choice, paying for it while preserving personal assets.

Financing nursing facility care should be approached with as much thought and preparation as any major expense. For more information, see "Paying for Long Term Care," and "Understanding Long Term Care Insurance" in AHCA's Consumer's Guide series.

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