Seniors who rely on Medicare to pay their nursing home costs are in for a shock when they find out it pays little to nothing and they are forced them to pay the bill from their own funds. At a cost of $15,000 to $20,000 per month, nursing home costs can quickly drain a person’s life savings if a proper plan is not in effect.
Many seniors think that if they enter a nursing home, or if they have other long-term care expenses, that Medicare will cover the cost leaving them with only the co-pay. But this is not accurate. Whether Medicare pays the costs depends on whether the patient needs custodial care or skilled care. Medicare does not pay for custodial care which is the type of care usually needed on a long-term basis.
“Even if Medicare provides coverage it only does so for a maximum of 100 days during an illness and will only pay the first 20 days in full for those who qualify,” says Robert J. Kurre, Esq., a Certified Elder Law Attorney. “After that, in 2022, the patient’s co-pay is $194.50 per day for days 21 through 100. Seniors sometimes buy a supplemental policy, known as a Medi-gap insurance policy, to cover the co-pay. After the 100th day, Medicare and the supplemental insurance no longer provide any coverage.”
People often don’t realize that the 100 days of Medicare coverage in a nursing home are not guaranteed. Kurre says, “For many people, Medicare does not pay for even one day of nursing home care, such as in those cases where a person needs only custodial care.”
Whether the patient is eligible for Medicare is initially the nursing home’s decision. If the patient is declared ineligible, he or she may appeal. An intermediary then reviews the file and makes a determination. And if the patient is still not approved for coverage, the next step is an administrative appeal.
Kurre says, “Our health care system discriminates based on the type of illness you have. For example, if a person needs heart surgery, has cancer, or needs a hip or knee replaced, Medicare will provide coverage subject to deductibles and co-payments. However, if the patient gets the wrong disease, such as Alzheimer’s, Parkinson’s, or ALS, Medicare pays little to nothing because the person only needs custodial care.” Kurre advises seniors to be proactive and create a plan to protect their home and life savings. “If you sit back and expect Medicare to pay the bill, you’re making a huge mistake that could bankrupt you.” He recommends that seniors get help from a seasoned elder law attorney who is skilled in navigating the complex laws concerning Medicare and Medicaid
