What assets have to be used up before medicare will pay for staying in a nursing homes?
Answer:
Medicare is insurance for acute illnesses of older Americans and certain disabled younger Americans. If a senior is enrolled in Medicare Parts A and Part B, bills pertaining to procedures that are deemed "medically necessary" will be paid for because it is insurance.
"Medically necessary" is the most important Medicare term. Medicare will not pay for any procedure or care that is not deemed as necessary for the recovery or rehabilitation of a patient. A lot of people think Medicare will pay for all of one's nursing home stay. Yes, Medicare will pay for limited days of nursing home care that is "medically necessary" recovery after, say, a hip replacement or after a hospitalization for some other health episode. But, if the doctor determines that there will be no further recovery for a person--say someone who just has suffered a stroke and is as good as they are going to ever be physically,--well, Medicare benefits for that particular health episode basically end. Again, Medicare is insurance primarily for acute illnesses--it was not designed to pay for the costs of day-to-day custodial care--services many vulnerable older people absolutely need to stay healthy like bathing, feeding, toileting, etc.
Many--and I do mean a whole lot of people I know-- get Medicare confused with Medicaid. Medicaid is a health insurance program for the poor or "medically indigent." Medicaid is only available to folks who meet rigorous financial guidelines. Now there is a five-year "look-back" period. This means older people can't just write checks to their family members or put assets into family members' names in order to qualify for Medicaid. If one qualifies for Medicaid--and folks at the state level determine this--then costs for medical care or the nursing home will be paid. Of course, someone pays this cost, because doctors' offices, hospitals and nursing homes have to pay their bills--and that "someone" is the taxpayers. The costs for Medicaid services are shared by the state government and by the federal government.
States' policies on estate recovery under Medicaid can differ.
Many seniors have their nursing home care paid by Medicaid. Others who qualify for Medicaid get in-home services they need paid for by Medicaid in many states under programs called the "Medicaid waiver". There is help available to seniors and family members who consider "home" the first choice for care.
There is a lot more to know about Medicare and about Medicaid. If you are an older person or someone researching this question for an older relative or friend, you might consider calling your local Area Agency on Aging. If you live in the United States or one of the territories, there is one serving your area. You can call toll-free 1-800-677-1116 to find out the one serving you. Each Area Agency on Aging has professionals available to answer questions like this one. They are also experts at options to nursing homes--like the Medicaid waiver program. You will most likely find the people there friendly and very helpful.
If you do contact your local area agency on aging and like the help that they give you, let your local county officials and your folks in Congress know. Area Agencies on Aging don't have big budgets for advertising--they are one of the best kept secrets for information about Medicare and Medicaid!
Good luck and best wishes!
As sad as it is they wait until you have almost nothing left!..you go threw your life savings then they say OK we can help you now!
If your parents are on Medicare, a person is covered for a nursing home for up to 21 days. After that she could get help again from Medicare for Home Health Nurses to follow up at their home and also send in bath aides, physical therapy and occupational therapy. Make sure that you ask for her to be evaluated for all of those things as they are covered.
DO NOT hide any money as it is against the law and your Dad will not be happy with the resulting circumstances. The state will not leave your father w/o funds as it's always divided so as not to impoverish the spouse. Medicaid picks up the tab once the funds are 2500.00 for a single person but I do not know what it is for a couple. Your Adult and Family Services Agency can help you with these questions for your state however. Call them or ask the discharge planner at the hospital for the numbers if you weren't given the information at discharge.
The person in a nursing home under medicaid turns over all assets to the state except for $30 per month. $5000 plus the interest it will earn can be placed in an account for burial expenses.
The answers post by the user, for information only, BAnswer.com does not guarantee the right.
Other Questions and Answers: