doctors, meds, and what about therapy, will you have to pay separately for those things.
If you Private Pay in a Nursing Home, Then Will your Regular Medical Insurance And Medicaid Pick Up On?
Sun, Sep 27, 2009
2 Responses to “If you Private Pay in a Nursing Home, Then Will your Regular Medical Insurance And Medicaid Pick Up On?”
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September 27th, 2009 at 3:16 pm
Private Pay Patients
Patients who finance the cost of care on their own, without assistance from government programs, are known as “private pay” patients. These individuals pay for their care through personal funds or a long-term care insurance policy
Is Nursing Home Care What The Patient Really Needs?
Don’t assume that just because a person needs daily help that nursing home care is what they need. Medicaid pays for nursing home care only when the patient needs care that can only be given in a nursing home. For this reason,
you should make sure that nursing home care is really what is needed before you sign a nursing home contract.
With nursing home charges reaching $3,000 or more per month, few families can long support a loved one in a nursing home with only their own funds. MediCARE gives little coverage for skilled nursing care and no coverage at all for ordinary nursing home care. (Medicare is the health insurance program for people who receive Social Security retirement or Social Security disability payments.) Long term care insurance is costly and some policies have serious limitations. Also, someone who already has a medical condition which is likely to put them in a nursing home will not be able to get such a policy
Medicaid pays for nursing home care only when the patient needs care that can only be given in a nursing home
Many people fear that they must give up their home and become impoverished in order to to get Medicaid.
Medicaid provides important protections for the nursing home patient and the patient’s spouse and dependents.
To have Medicaid pay for their nursing home care, a person must:
• Live in a nursing home that takes Medicaid payments, or expect to go into one, and
• Have had or expect to get medical care for 30 days in a row, and
• Meet Medicaid’s medical guidelines for needing nursing home care
• Meet Medicaid’s financial guidelines.
If the person meets all of these requirements,
Medicaid will pay for her future nursing home care. It can pay for her nursing home care for 3 months before she applied for Medicaid
The Medical Application for Medicaid
Medicaid pays for nursing home care only when the patient needs daily nursing services that, as a practical matter can only be give in a nursing hme. care that can only be given in a nursing home
The Financial Application for Medicaid
The Medicaid case worker will ask for financial information
from the past three years or, in some cases, from the past five years.
The Medicaid worker looks at three parts of a patient’s finances
* Income
• Assets (also called “resources” and “property”)
• Transfers of property or assets made during the three years before the Medicaid application (five years if the transfer is from a trust)
The Medicaid worker will also look at any property the patient holds jointly, including any bank accounts showing the applicant’s name
To qualify for Medicaid, the patient’s income must be less than $3,937 (vendor payment rate plus monthly medical expenses).
If a patient’s income is too high for Medicaid, ask the nursing home how much they would charge without Medicaid.
This is called the “private pay rate.” Ask them to include the projected cost of the patient’s medicine and supplies.
If the patient has enough income to pay these expenses, she may not need Medicaid at this time
What if her income is less than the private pay rate plus her medicine? She may quality for Medicaid even though her income is above the Medicaid guidelines.
Medicaid is a government program for the indigent over 65. Most of us never want to depend on the government to pay our bills because we have no money and/or assets left, but nearly two-thirds of residents currently in nursing homes are in that very situation. They do not have sufficient income and have spent their savings so Medicaid pays the nursing home bill. Keep in mind that half of us will never enter a nursing home and most who do enter a nursing home stay only a short time, so the likelihood of spending our savings and then being on Medicaid is low
Why not give the money or assets away before entering a nursing home to preserve those assets? It is against the law! Criminal penalties may be imposed on those who have transferred assets to heirs with the aim of qualifying for Medicaid and protecting the transferred assets from being claimed by Medicaid. Even if assets are transferred without the aim of qualifying for Medicaid, Medicaid can claim a portion of those assets if transferred too close to making application for Medicaid. Gifts to other people must be transferred three years prior to Medicaid application for Medicaid to not claim a portion of the value of that gift. Gifts to trusts must be made five years prior to Medicaid application for Medicaid to not claim a portion of the gift. However, if the grantor retains any control of assets placed in the trust or if the trust is revocable (the grantor may regain contGifts to trusts must be made five years prior to Medicaid application for Medicaid to not claim a portion of the gift. However, if the grantor retains any control of assets placed in the trust or if the trust is revocable (the grantor may regain control of assets), assets are considered by Medicaid, or for that matter by probate courts, to still be owned by the grantor..
November 29th, 2009 at 11:46 pm
How much is the premium per month for the Class Act? I know you have to pay in for five years for it to be active unlike long term care insurance, and it only covers home care.