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Need Nursing Home Care? Here’s What to Do When Medicare Ends

Need Nursing Home Care? Here’s What to Do When Medicare Ends

When you or your loved one ends up entering into a nursing home after a hospital stay, there is often concern about who will pay for care. Nursing home care can easily cost over $450 a day. If rehabilitation is involved, it can be even more expensive.

If a patient has been in the hospital for three days, then enters a nursing home, Medicare will pay for this care. During the first 20 days a person is in a nursing home, care is paid 100%. The following 80 days will be partially paid, but there is a $ 157.50 co-pay each day. For many people, supplemental insurance will cover this expense. If you have this type of policy, and you should, it will cover most of these costs.

However, there is a catch. Medicare only pays if the patient meets certain guidelines in regard to rehabilitation. If the patient wants to stop rehab or if it is determined that the  patient no longer needs skilled care, then  Medicare coverage will stop, even if the 100 days is not over. When Medicare stops, supplemental insurance will also stop, which means that the patient will owe an average of $10,000 to $13,000 or more each month. Because these rules exist, the family needs to encourage both the facility and the patient to give their full efforts during rehabilitation so that the benefits will not cut off before the100 days are over.

What happens if you are successful at rehab, go home, and end up back at the hospital at a later date? That 100 day clock will start over as long as there has been 60 days between the stays. This is not unlimited, but it is rare that anyone ever reaches the lifetime limit on this benefit.

What advice should be taken away from this article? Make sure to have a supplemental insurance policy, also known as a “Medigap” policy, in place and to encourage any loved one who is in rehab to continue as much as possible. If you don’t have one of these policies, make sure to see an elder law attorney as soon as possible to find out what you can do to sign up for one.

Attorneys Stephen O. Allaire (Of Counsel) and Halley C. Allaire are partners in the law firm of Allaire Elder Law.
Attorneys Stephen O. Allaire (Of Counsel) and Halley C. Allaire are members of the National Academy of Elder Law. Attorneys, Inc.
Allaire Elder Law is a highly respected, and highly rated law firm with offices in Bristol, CT.
We can be contacted by phone at (860) 259-1500 or by email.

If you have a question, send a written note to us and we may use your question in a future column.




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