Is a Nursing Home Plan Worth It? Five Key Takeaways About Medicare and Skilled Nursing Facilities

Long-term care is a part of life that no one wants to expect, but everyone should plan for. The Administration for Community Living estimates that “someone turning 65 today has almost a 70% chance of needing some type of long-term care service in their remaining years.”  

While a nursing home may seem lifetimes away, it is never too early to start planning for your future. The last thing you’d want is to need long-term care and not have a plan for how to pay for it.  

That’s where we come in. Not only is it great to keep long-term care in your mental peripherals, it is also vital to have a concrete plan for that time in your life through insurance.  

Besides the cost advantage of having insurance, the peace of mind that it affords consumers is invaluable. Let’s see if long-term care insurance is right for you.  

Does Medicare cover nursing home care?

The long and short of this answer is kind of.  

Medicare does cover nursing home care, but that coverage is very limited:

• ‍On days 1–20 in a skilled nursing facility, all Medicare-covered services are paid at no cost to you.
• ‍Days 21–100 are covered by Medicare, but you must pay the coinsurance out of pocket. A coinsurance rate is basically your share of the cost of medical services after your deductible.
• The typical daily coinsurance amount for a skilled nursing facility in 2021 is around $185.50, or 1/8 of the inpatient hospital deductible for the calendar year. However, this is subject to change each year. Further, depending on whether or not you have Medigap or Medicare Advantage coverage, your coinsurance rates may have coverage that is not offered by traditional Medicare.
• From day 101 through the rest of your stay, Medicare pays nothing. Whether the service is covered by Medicare or not, you will pay the full cost out of pocket.  

How much does Medicare pay for nursing home?  

Medicare pays for limited services in a nursing home. Original Medicare covers only medically necessary, skilled care at a long-term care facility.

However, most care that occurs at a nursing home has to do with daily living, like bathing, dressing and using the bathroom. These “non-medically necessary” services would not be covered.  

However, this only works at a Medicare- or Medicaid-certified long-term care facility.

Who pays for your nursing home if you have no money?

Because Medicaid is a financial assistance program, it serves low-income individuals. As a joint federal and state plan, each state has different levels of flexibility on benefits and eligibility criteria. If you cannot pay for a nursing home and you are deemed unable to live on your own, Medicaid may pay for a long-term care facility.  

However, Medicaid assistance should not be something that you count on for your future nursing home needs. If your Medicaid coverage pays for your care, that means that you do not get any choice in the facility. You will likely end up going wherever is cheapest, regardless of the quality.  

Additionally, your assets can become severely depleted to match Medicaid resource limits.  

How long does Medicare cover your stay in a nursing home?

As stated above, Medicare will provide varying levels of coverage for up to 100 days of care at a skilled nursing facility.  

After 100 days, you will have to pay out of pocket for your care if you rely on traditional Medicare for all of your health coverage.  

Note: If you have spent time in a long-term care facility, the staff is under no obligation to provide you with notice when you start to run out of days. To avoid unexpected costs, you or your caregiver will need to be aware of the number of days you have been in care.

After your first 100-day stay at a skilled nursing facility, you can become eligible for Medicare coverage of your long-term care again. Once you have been out of the nursing home for 60 days in a row, you can transition to a new benefits period — including 100 more days of care —after a qualifying three-day inpatient hospital stay.  

Is long-term care insurance worth it?

Long-term care insurance is the saving grace for those whose Medicare coverage has run out during a long-term care stay.  

The short answer is: Yes! It’s worth it!

We have watched enough Americans gain incredible peace of mind and worthwhile benefits from long-term care insurance to know that extra security is usually a good idea.  

Traditional Medicare only partially covers skilled nursing facilities for 100 days, so it’s important to have a solution after that coverage stops.  

After all, skilled nursing facilities can be one of the most expensive needs you ever have in your lifetime. Odds are high that you will need some form of long-term care at some point, so why not be prepared?

If you don’t know how you would plan to pay for long-term care, give us a call. You will reach a licensed insurance agent when you do, and they will sort through the nitty-gritty details with you and find a solution that works.  

Conclusion

There is a high likelihood that everyone will need long-term care at some point, so why not get in front of that worry right now and put it to bed with great coverage?

Call us now to get quotes for different nursing home plans to fit your needs. We have several different products to consider, including long-term care insurance, short-term care insurance or a hybrid insurance policy.