An Insider’s Guide to paying for Nursing Homes

Long Term Care, Rehab Care, Skilled Nursing Care are all common terms for Nursing Home care.

All nursing homes in the State of Ohio are licensed by the Ohio Department of Health.  Each must abide by strict care guidelines and annual surveys to assess measuresrelated to Quality of Care and Services.  Nursing homes come in many shapes and sizes; small to large, privately owned, not for profit, etc.  Rehab centers, such as those in local hospitals may be licensed as Nursing Homes.  

Generally, there are four types of payment for Nursing Home care:

• Private Pay-The community will charge a daily rate and it is paid via personal funds • Medicare/Medicare Advantage • Medicaid • Other-including Private Insurances

Long Term Care Insurance, VA payment, Aid and Attendance for veterans and spouses of veterans who served during times of war, etc. are all part of the Other category.

People often believe that “Medicare pays for everything”.  A physician may have recommended a short stay for rehab care, or perhaps a respite stay or even hospice care.  Medicare does pay for some types of care within a nursing home but not always.  Certain guidelines must be met. With traditional Medicare the patient must also require skilled care services. A good rule of thumb to remember is Medicare will pay 20 days at 100% and 80 days at 80%. Supplemental “Gap” insurance may cover the balance during the first 100 days. There are several different Medicare Advantage Plans that all have their own coverage rules.  For more information on both Traditional Medicare and Medicare Advantage plans visit:  https://www.medicare.gov

Medicaid is the largest single payer for nursing home care. Medicaid requires an application process with eligibility guidelines based on income and asset limitations.  To qualify individuals must meet specific requirements that vary depending on age, marital status and state of residence. Financially, their monthly income cannot be greater than $2,250 (or annually $27,000).  

Persons with both Medicare and Medicaid may also be enrolled in a Medicaid Managed Care program.  This payment source also has its own guidelines for coverage.For more information, visithttps://www.medicaid.ohio.gov/FOR-OHIOANS/Programs#623546-long-term-care

Long Term Care Insurance is designed to help pay for Long Term Care (LTC) services provided either at home or at a licensed facility. A range of care options and benefits can be selected to fit the services needed by the individual. Long-term care insurance premiums are based on the age at the time of the application for coverage.

Some nursing homes may have a contract or relationship with the local VA to provide services to veterans.  Veterans and/or spouses of veterans may also be eligible for financial assistance via a program known as Aid and Attendance.  To quality, the veteran must have served during a time of war.  To learn more, visit https://www.vets.gov/pension/aid-attendance-housebound/

For more information about resources available to assist with paying for nursing home care, contacting the Western Reserve Area Agency on Aging at https://www.areaagingsolutions.org/contact/ Additionally, you may reach out to Gateway Retirement Community at.  216-532-1124.