TOP 5 QUESTIONS ABOUT NURSING HOME REHABILITATION: ANSWERED

QUESTION ONE: Does Medicare cover skilled nursing or rehabilitation services?

To qualify for Medicare coverage for skilled nursing or rehabilitation services, you must meet specific requirements:

1. You are enrolled in Medicare Part A.
2. You have remaining days in your Medicare Part A benefit period.
3. Your physician recommends skilled nursing or rehabilitation services.
4. You were admitted to a hospital and received care for at least 3 days.
5. You are receiving your skilled nursing or rehabilitation in a Medicare-approved facility.

If you meet these qualifications, Medicare will cover 100% of the charges for the first 20 days in a nursing and rehabilitation center. From day 21 to day 100, Medicare pays 80% of the costs, while you are responsible for the remaining 20% unless your coinsurance covers it.

Please note that if your condition does not improve, and your physician and therapy team no longer recommend skilled nursing or therapy services, you may not qualify for the full 100-day coverage.

If you have a different health insurance plan, contact your provider to understand your coverage as some plans may not offer the full 100-day benefit period.

QUESTION TWO: What happens when my insurance coverage ends?

Once your insurance benefits end, if you require custodial care, the nursing home will charge you a daily fee for private room and board. Additional charges may apply for services like laundry, beauty/barber services, medical supplies, and medications. The cost of nursing home care can exceed $15,000 per month.

QUESTION THREE: Can the nursing facility take my home?

The nursing facility will not take ownership of your home. However, in certain cases, you may need to sell your home to cover the cost of care after your insurance benefits cease. An elder law attorney can guide you through asset protection options to safeguard your home and assets from care costs. Special spousal impoverishment rules exist to protect your spouse from losing their home if you are married.

QUESTION FOUR: How do I qualify for Medicaid benefits to pay for my care?

If you are single, you may qualify for Medicaid if your income is below the monthly nursing home cost, and your resources are below $2,500. Your home is typically not counted as an asset as long as you plan to return to it. Medicaid also excludes certain life insurance policies and irrevocable burial accounts.

If you are married, you will need to file a resource assessment form with the County Department of Social Services (DSS) office. The assessment lists the assets you owned on the date of admission to the nursing facility. The DSS calculates a protected share for your spouse living in the community, allowing them to keep half of the countable resources within certain limits. The spousal share varies based on the year. Some assets, like a motor vehicle, certain life insurance policies, and irrevocable burial accounts, are not counted. Excess resources determined by the DSS must be spent down.

Medicaid has a five-year “look-back” period for gifting. If you made a countable gift within five years of applying for Medicaid nursing home benefits, you may face a period of ineligibility once you have met the resource spend-down. The length of ineligibility is calculated based on the gift amount.

QUESTION FIVE: Will the nursing home keep my income once I qualify for Medicaid?

After qualifying for Medicaid, you will be required to contribute your monthly income towards the cost of nursing home care. The amount you pay is determined by deducting a personal needs allowance (e.g., $93) and health insurance premiums from your gross monthly income. The remaining balance is then paid to the nursing home.

If you are married, your spouse may be entitled to keep a portion of your income.

Paying for long-term care and navigating Medicaid eligibility can be complex and confusing. At The Elder Law Office of David Wingate, we offer an initial consultation to help you understand and qualify for benefits that can cover your long-term care costs. To reach our office, you can call us at (301) 663-9230 or visit our website at www.davidwingate.com.

Please note that this information is provided as a general guide and may vary based on individual circumstances and regional regulations. It is always recommended to consult with an elder law attorney or a qualified professional to receive personalized advice regarding your specific situation.

To learn more about estate planning and elder law, visit Estate and Elder Planning by David Wingate at www.davidwingate.com. For an Initial Consultation, call (301) 663-9230. We can assist you with powers of attorneys, living wills, wills, trusts, Medicaid planning, and asset protection. With office locations in Frederick, Washington, and Montgomery Counties, Maryland, we are here to provide you with peace of mind.

Disclaimer:

The information provided in this blog post is for general informational purposes only and should not be construed as legal advice. While we strive to provide accurate and up-to-date information, laws and regulations regarding dementia, estate planning, and elder law can vary by jurisdiction and may change over time.

The content of this blog post is not intended to create an attorney-client relationship between the reader and Estate and Elder Planning by David Wingate or any of its attorneys. It is always recommended to seek professional legal advice tailored to your specific situation from a qualified attorney.

The applicability of legal principles can vary based on individual circumstances, and the information provided in this blog post may not necessarily address all possible legal issues or concerns. Therefore, it is advisable to consult with an experienced attorney before making any decisions or taking any actions based on the information provided in this blog post.

Estate and Elder Planning by David Wingate assumes no responsibility for any errors or omissions in the content of this blog post or for the accuracy, completeness, or adequacy of the information contained herein. Any reliance on the information provided in this blog post is at the reader’s own risk.

The inclusion of any links or references to external websites or resources does not imply endorsement or recommendation by Estate and Elder Planning by David Wingate. We cannot guarantee the accuracy or accessibility of the information on linked websites, and we are not responsible for any content or services provided on these sites.

We encourage readers to consult with an attorney regarding their specific legal concerns and to obtain professional advice tailored to their individual circumstances. Each person’s situation is unique, and the information provided in this blog post may not be applicable to everyone.

By reading this blog post, you acknowledge and agree that Estate and Elder Planning by David Wingate, its attorneys, and agents are not responsible or liable for any damages or losses arising from your reliance on the information provided herein.

Always consult with a qualified attorney for advice regarding your individual legal situation.