Currently, care in a nursing costs an average of $224 per day, so it is a good idea to review all the possible payment options to determine if your loved one is eligible for any third-party coverage. If not, then paying directly for care may be the only option, unless and until your loved one becomes eligible for third-party coverage.
PAYMENT SOURCES
PRIVATE
PAY
Some nursing home residents pay privately for care during their
entire stay. Others enter covered by the Medicare program and
pay privately
when that coverage ends. Yet others pay privately when they are first
admitted, and later become eligible for Maryland Medical Assistance
when their asset level diminishes. (An individual may begin paying
privately for care and, when he or she has spent down the assets
to meet the financial eligibility requirements of the Medical Assistance
Program, then make application for that program.)
If you plan to pay privately during any part of the stay, make sure you review the admission contract carefully and be sure you understand what is included in the daily rate and what charges are extra.
Also, remember that the extent of personal and out-of-pocket medical expenses will depend on your loved one's needs and desires.
MEDICAL ASSISTANCE (MEDICAID)
Most freestanding nursing homes in Maryland accept Medical Assistance
funding, as do some nursing homes that are part of retirement
communities.
To be eligible for Medical Assistance
funding for nursing home care, an individual must meet medical and financial requirements.
Financial eligibility for Medical Assistance is based on one's income and assets. In the case of a married applicant, eligibility is determined by combining both spouses' income and assets.
Income includes wages, Social Security and pension benefits, interest from savings accounts and investment earnings.
Assets include cash (for example, bank accounts) and things that could be converted to cash (for example, stocks, bonds, real estate and the cash value of life insurance policies).
The Legal Aid Bureau has developed a Question and Answer document to help you understand more about Medical Assistance for nursing home care.
Maryland Medical Assistance Application Process
Statewide, the local Department
of Social Services
processes all applications for the Maryland Medical Assistance Program.
In
Baltimore
County the Towson office handles these applications. Call
for an appointment.
MEDICARE
Medicare
Part A covers the cost of skilled
care in a
skilled nursing facility (SNF) for a limited time. Most
people are medically eligible for skilled care for only a limited
period of time.
The
Medicare benefit covers 100% of the cost of skilled care for up to the
first 20 days. If skilled care is still required
for days 21-100 (or any portion thereof), the resident will be responsible
for paying $114 per day. There is a limit of 100 days of Medicare Part
A SNF coverage in each benefit period. A benefit period begins the day
one goes to a hospital (or skilled nursing facility) and ends when the
resident has not received any hospital or skilled nursing facility care
for 60 consecutive days.
LONG-TERM CARE INSURANCE
Long-term care insurance can help pay for nursing home care. This insurance
may also cover the cost of in-home care, adult day care, assisted living
and services provided in continuing care communities. The amount of coverage
and the eligibility requirements may differ. If your loved one has a policy,
read it carefully. Note: Some policies may specify that they will pay for
services only in some state-licensed facilities.
DEPARTMENT
OF VETERANS
AFFAIRS
A veteran with a service-connected disability rated at 70% or more or
a veteran whose service-connected disability is clinically determined
to
require nursing home care, may qualify for care in a VA nursing home
or a nursing home that has an ongoing contract with the VA. The Department
of Veteran Affairs details
information about nursing home eligibility and other benefits for veterans.
There are a number of expenses a nursing home resident may incur that are not covered by any insurance. Personal expenses (such as clothing, telephone and television) and out-of-pocket medical expenses will vary depending on your loved one's wants and needs.