When deciding to place your loved one in a Florida nursing home, there are many things that you need to consider. One of the most important things you need to take into account is how to pay for care. Depending on the senior’s needs, there are different payment options and plans that you may qualify for.
In order for a senior to have Medicare coverage for some nursing home costs, they must be placed in a Medicare-certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay refers to the amount of time spent in a hospital immediately before placement in a nursing facility. The minimum amount of time required for a qualifying hospital stay is three days. Medicare nursing home coverage is separated into two parts; hospital insurance and supplementary medical insurance.
Medicare hospital insurance is automatically provided for patients age 65 and older who are entitled to Social Security or to patents that are disabled and have received benefits for a minimum of two years. Health services covered under hospital insurance include:
- Skilled Nursing Facility: Must be within 30 days of a qualifying hospital stay and deemed necessary by a medical professional. Coverage is for up to 100 days, with a co-payment after the first 20 days. Does not cover long-term care.
- Home Health Agency Care: Covers medical care in the home of the patient as provided by a home health agency.
- Hospice Care: Intended for terminally-ill patients who are expected to live for six months or less.
- Inpatient Hospital Care: Covers the cost of most hospital services.
Supplementary Medical Insurance
Most U.S. citizen’s 65-years-old or older, certain aliens 65-years-old or older and disabled patients are covered by Medicare’s supplementary medical insurance. This type of coverage requires a monthly premium and covers most physician services, tests, ambulance services, lab tests, vaccinations and some therapeutic services.
Medicaid covers most nursing home costs for individuals with low income and assets. In order for a qualified patient to receive coverage benefits, they must be placed in a Medicaid-certified nursing facility. Currently, Medicaid will pay for 60 percent of nursing facility care. If your senior’s needs are better met through an assisted living facility or a home health aid, Medicaid will cover approximately 10 percent of the costs, with a majority of the expenses paid through private funds.
According to Medicare.gov, about half of all nursing home residents pay facility costs out of their own pockets. Once a resident has exhausted all their personal savings and resources, most patients become eligible for Medicaid coverage.
Long-Term Care Insurance
Long-term care insurance policies are a popular option among residents with sizable assets that they wish to protect. These types of insurance policies can be purchased through a private insurance company or are provided for by some employers. Long-term care insurance policy premiums are based on the age of the patient at the time of purchase, the benefit amount, the coverage period and other special options such as inflation adjustment and non-forfeiture benefits. These policies usually cover placement and care in licensed nursing home facilities and home health care.
Florida Nursing Home Financial Counseling and Assistance
Even with a wealth of knowledge, determining your best payment options can still be overwhelming. Most states have State Health Insurance Assistance Programs (SHIPs) with counselors who are available to answer questions regarding how to pay for nursing home care, coverage the resident may already be entitled to, or which government programs you and your loved one may be qualified for. If you would like help from Florida’s SHIP, visit www.floridashine.org.