When Does Insurance Cover Nursing Home Costs?
Nursing home costs are very high, with bills for nursing home care totaling thousands of dollars every single month. If you are forced to pay for the costs of care out of your own pocket, you will end up spending your entire life savings very quickly. You do not want to lose your entire nest egg and everything that you have worked for over the course of your life, just because you need to go into a nursing home. Instead, it is best to make an advanced plan so your nursing home care costs will be covered.
As they make plans for nursing home care, many people want to know if their insurance will cover the bills. While coverage can vary from policy to policy, generally there are only a very limited number of situations in which insurance will cover nursing home care costs. To make sure you can get your bills paid when and if you need care, you need to talk with an experienced asset protection and nursing home planning lawyer. Zimmer Law Firm can help, so give us a call today.
When are Nursing Home Costs Covered by Insurance?
Nursing home costs are covered only in very limited situations by a private insurance provider or by Medicare. Medicare explains that custodial care is not covered by Medicare Part A.
The only time Part A covers nursing home care is when you need skilled medical services. For example, if you have an operation and need a nurse to change your surgical dressing, Medicare will pay for a nursing home for a limited period of time while you receive these skilled services. Most people, however, don’t need a nursing home for a short time just because they need skilled services- they need long-term custodial care because they become unable to live by themselves.
Private insurers have their own policy terms, which you can find out about by reviewing your insurance policy and coverage limitations. In general, however, private policies- including Medicare Advantage Plans- are going to cover only what Medicare covers when it comes to nursing homes. This means they are usually going to pay only for skilled medical services and they are usually going to offer this coverage only for short periods.
How to Get Your Nursing Home Costs Covered
For most people who need skilled nursing home care services, the fact Medicare and their insurers won’t pay can be a big problem. If insurance won’t pay, your only option is to pay yourself.
To prevent this from happening, some people purchase long-term care insurance. However, if you did not plan well in advance and purchase this kind of policy when you were young, the premiums can be prohibitively high or coverage may not be available at all. Long-term care policies are also hit-or-miss, with some insurers and policies much better than others. Some long-term care providers impose so many limitations on coverage or set reimbursement rates so low that the policies do not end up providing the expected protection.
If you don’t have long-term care insurance and do not want to pay out of pocket, or cannot afford to pay out of pocket, there is one last option: Medicaid. Medicaid covers custodial care and is one of the primary payers of all nursing home bills throughout Ohio and the United States. If you can get Medicaid to cover your care, you will have nothing to worry about.
The only problem is, Medicaid is needs-based, and there is a resource limit. This means you could end up having to spend your money before you get covered, since Medicaid will kick in only when your assets drop below the allowable resource level (which is just $1,500 in Ohio).
You can avoid having to spend down your money by making a Medicaid plan, but to get the best protection for assets, the planning needs to be completed five or more years before you need nursing home care. This is why you should not wait to protect assets.
Contact a Cincinnati Nursing Home Lawyer for Nursing Home Planning Help
Zimmer Law Firm provides you with assistance in understanding your options for getting nursing home bills paid. We can also help you to make a plan to protect your assets and qualify for Medicaid coverage when nursing home care becomes necessary. To find out more about the ways in which we assist you with keeping your nest egg secure and getting nursing home bills paid, give us a call at 513.721.1513. You can also join us for a free seminar to find out more about the nursing home planning process.