Our office frequently receives calls from adult children whose parents have entered or are about to enter long-term nursing care. Accustomed to Medicare covering their parent’s medical bills, they now face a frightening fact: Medicare will not cover their parent’s custodial nursing home care. The family is staring at an annual cost of $100,000 or more.
The misconception about Medicare coverage is widespread and understandable. The term “nursing care” is a catchall phrase, and as a result most people do not realize it includes both skilled nursing care and long-term nursing care. These two types of care serve different purposes, and the coverage available for each is different, too.
Medicare May Cover Skilled Nursing Care
Medicare is a federal program administered by the Centers for Medicare and Medicaid Services. Medicare will pay for nursing care – but only if it is skilled nursing, and only under certain circumstances:
- It covers only up to 100 days of care.
- Starting at day 21, the patient is required to pay a co-payment equal to one eighth of the initial hospital deductible cost.
- Coverage is available only if the patient was hospitalized for at least 3 days prior to admission to the nursing facility.
- The problem being treated with skilled nursing must be the same problem the patient was treated for during the hospital stay.
- The patient must enter the skilled nursing facility no more than 30 days after hospital discharge.
An important caveat: Medicare will not cover skilled nursing if the patient has been classified as being on observation status during the preceding hospital stay. Read more about observation status.
Medicaid May Cover Long-Term Nursing Care
Medicaid is a federal program administered in conjunction with the states. Different states have somewhat different rules. Thus, if you qualify for Medicaid benefits in a state outside Florida, you may not qualify in Florida, or vice versa.
Long-term nursing care is custodial care. Unlike skilled nursing care, its purpose is not to restore a person to independence and good health. Its goal is to help individuals with the activities of daily living they can no longer perform independently. Examples of such activities are bathing, eating, toileting.
Medicaid will pay for long-term nursing care but only under certain conditions. In order to get Medicaid coverage for long-term care, the applicant may have no more than $2,000 in countable assets. Certain assets, such as homestead, may be exempt. There is also a five-year look-back period. This means that Florida Medicaid examines an applicant’s expenditures in the five year period prior to application. If the applicant has made gifts below fair market value during that time period, there will be a penalty period during which the applicant is ineligible for benefits, even if qualified in all other respects. An expanded list of eligibility requirements for Florida can be found here.
Medicaid rules are very complex and the system hugely difficult to navigate. Families struggling to pay for a loved one’s long-term care who want to tap into Medicaid benefits are well advised to consult with an experienced elder law attorney. The Karp Law Firm may be able to help you preserve assets even if your loved one has already entered a long-term nursing facility. We can also help people who are planning in advance with techniques such as a Medicaid Asset Protection Trust. Call our attorneys at 561-625-1100 or email us klf@karplaw.com to schedule your consultation.
