Information About Paying for Nursing Home Costs
Nursing homes and other healthcare costs can be expensive, so in cases of neglect by a healthcare facility, sometimes hiring a top nursing home lawyer Wheaton MD provides is a good option for getting justice. The legal firm of Cohen and Cohen, P.C. has helped victims of personal injuries and medical malpractice get justice for the last two decades. Our attorneys have settled thousands of cases and recovered millions of dollars on behalf of our clients.
A top nursing home lawyer Wheaton MD offers may be able to help families right the wrongs perpetrated by neglectful and abusive caregivers. In addition to concerns about possible abuse of your loved one, there is also the stress involved of paying for an elder family member’s long term healthcare. Questions of a legal matter are best addressed by a nursing home lawyer in Wheaton MD. The following information may be helpful to you in choosing the best payment options for your loved one depending on your family’s financial situation.
What is Medicare and Medicaid?
The Centers for Medicare and Medicaid services is a federal agency that operates the Medicare program. It also monitors each state’s Medicaid program.
Medicare covered 48.7 million people in 2011. It’s the federal health insurance program for people aged 65 and older. Others who qualify include certain younger people who have disabilities, and people with permanent kidney failure that requires dialysis or a transplant.
Medicare doesn’t pay for most nursing home care costs. It offers limited and medically necessary skilled care or home health care for those with an injury or illness and who meet certain conditions.
What costs does Medicare cover or not cover?
Medicare will cover up to 100 days per benefit period (and under certain conditions) for:
- Skilled care (therapy and nursing) within a skilled nursing facility
- This is for managing, treating, and observing a patient’s condition
Medicare doesn’t usually cover:
- Extended length stays in a nursing home
- Health coverage for physician services, hospital care, and medical equipment while staying in a nursing home
What costs does Medicaid cover or not cover?
Medicaid is a program run by the federal government in individual partnerships with each state. It’s intended to contribute to eligible people’s medical costs who have limited incomes. The majority of health costs are covered between Medicare and Medicaid.
- Most nursing home facilities accept Medicaid, but a nursing home lawyer Wheaton MD families trust might suggest you verify this in writing.
- Though your loved one may have the financial resources to initially pay for long term health care, as his or her savings dwindles, they may eventually qualify for Medicaid.
- Medicaid programs and benefits vary by state.
- Usually, Medicaid eligibility is based on a person’s income and assets or personal resources. Some states have stricter income requirements when it comes to covering nursing home costs. If your loved one has won a settlement from a facility in which they had been abused, a nursing home lawyer Wheaton MD victims rely on may be able to determine how the settlement may affect your loved one’s Medicaid eligibility.
- Even those eligible for Medicaid may have to use their entire income, less a monthly allowance and other necessities, to pay for nursing home costs with Medicaid covering the remaining balance.
For those who do not qualify for Medicaid or Medicare, they may have to consider using the following resources to pay for their long term health care costs:
- Life savings and liquified assets. There are additional rules specific to the liquidation of assets that can be explained in depth by a nursing home lawyer Wheaton MD clients respect.
- Some insurance companies will allow an insured to use their life insurance policy to pay for long term health care. A nursing home lawyer Wheaton MD residents turn to for legal advice may encourage you to verify this with your insurance company and get it in writing.
- The state cannot put a lien on the elder’s home if:
- There’s a reasonable expectation that he or she will return to it after getting nursing home care.
- If the elder has a spouse or dependents living in the house.
- After a nursing home resident who received Medicaid nursing home benefits passes away, the state is required to try to recover that money from the deceased’s estate. There are limits and restrictions when it comes to their right to put a lien on the deceased’s home. For more information on protecting the elder’s and the surviving family member’s rights, speak to a Wheaton MD nursing home lawyer.
How to Apply for Medicaid
There are several ways to apply for Medicaid:
- Call the state’s Medicaid office
- Visit the state’s Medicaid website online
- Apply in person at the state’s Medicaid office
- Through the state’s health insurance exchange
- If a nursing home resident or hospital patient needs to apply they may be able to do it over the phone with the help of the nursing home or hospital
Long-Term Health Care Insurance
This is private insurance that can help cover the costs of long-term health care. This can include skilled as well as non-skilled health care services.
- Policies vary in terms of coverage, benefits, and cost
- Some policies only cover nursing home care
- Other policies may include much broader coverage for many services including
- Assisted living health care
- Medical equipment
- Informal home care
- Members of the military, retirees, their spouses, and federal employees may qualify for discounts on policy costs
Medicare Advantage Plans and other Medicare Health Plans
Those with a Medicare Advantage Plan like a PPO or an HMO may cover nursing home health care costs. This is unusual though, unless the nursing home has an existing contract with that plan. A nursing home lawyer Wheaton MD clients trust might encourage you to check if your loved one’s plan has nursing home coverage. If a nursing home you’re considering moving your elder into has contracted coverage through the plan, ask the plan’s insurance company if they inspect the nursing home for quality of care.
Medicare Health and Prescription Drug Coverage
You may be able to get coverage for your loved one’s prescriptions from a long-term care pharmacy if:
- The pharmacy works with your loved one’s plan.
- If your loved one has a Medicare Prescription Drug Plan or
- Your loved one lives in a nursing home or other health care facility accepted by Medicare.
- Unless your loved one chose a Medicare health plan with drug coverage or a drug plan, Medicare can automatically enroll the elder family living in a healthcare facility with both Medicare and full Medicaid coverage.
- If your loved one lives in a nursing home and has full Medicaid coverage, they will likely not have to pay for any prescriptions covered under the policy after Medicaid has paid for their stay for at least a full calendar month.
If your loved one is in need of moving to another healthcare facility, or is about to enter one for the first time, your family may have concerns about how to pay for the costs. You may also be questioning if your loved one’s rights have been violated by a previous facility. The attorneys of Cohen and Cohen, P.C. have a combined knowledge of personal injury laws, malpractice suits, and health care regulations as they may apply to your loved one’s situation. When you need a nursing home lawyer Wheaton MD is proud to have in the community, call us immediately at Cohen and Cohen, P.C.