Whether you’re planning early for long-term care coverage or just now realizing you may need to pay for skilled nursing in the future, you need answers. While Medicare may cover some expenses, most long-term care generally falls on you. Find out how to prepare early for long-term care coverage!
Let’s look at those options now and see how to pay for long-term care, whether you’re desperate for answers or have just started looking. In this blog post, we will discuss whether Medicare pays for nursing home care in North Carolina and what other options are available to pay for long-term care.
What is a Skilled Nursing Facility?
As we age, the likelihood of needing long-term care increases. Long-term care includes skilled nursing care, rehabilitation, and custodial care services provided to individuals who cannot perform daily activities without assistance.
The cost of long-term care can be significant, and it can be a challenge for many seniors to find a way to pay for it without losing everything! Medical insurance generally does not cover skilled nursing facility care except for a short time.
Nursing home expenses can be a shock, mainly because everyone can’t depend on Medicare and Medicaid to provide what they need. Often, all the nursing home expenses come down to you and your plans (or lack thereof!)
What is Long-Term Skilled Nursing Care and Who Needs to Prepare for This Eventuality?
Long-term care is for those who need 24/7 care for conditions that prevent caring for themselves. Many physical and mental conditions may require medically necessary services around-the-clock, including:
- Dementia, including Alzheimer’s
- Other chronic medical conditions that require a nursing home facility
Those who can’t tackle the tasks of daily living need coverage for nursing home costs.
What Does Medicare Coverage Include?
Medicare is a federal health insurance program that covers individuals 65 or older, people with specific disabilities, and people with end-stage renal disease. Medicare does cover some nursing home care, but only in certain situations and for a limited period.
For example, Medicare may cover up to 100 days of skilled nursing care after a hospital stay of at least three days. However, Medicare benefits will only cover the total cost of skilled nursing facilities for the first 20 days, such as:
- A semiprivate room and meals.
- Skilled nursing services and care.
- Medical social services and dietary counseling.
- Medications, durable medical equipment and supplies used in the facility.
- Occupational therapy, physical therapy or speech and language pathology services if needed to meet your health goal.
- Ambulance transportation if needed to receive necessary services that aren’t available in the facility. (1)
After coverage ends, you’ll need to pay copayments for services.
According to Medicare.gov, “Medicare generally doesn’t cover long-term care stays in a nursing home. Even if Medicare doesn’t cover your nursing home care, you’ll still need Medicare for hospital care, doctor services, and medical supplies while you’re in the nursing home. Find out what cost of nursing home care Medicare does cover and how Medicare prescription drug coverage (Part D) works if you live in a nursing home or other institution.
Most people who enter nursing homes start by paying for their care out-of-pocket.”
Medicare will cover nursing home care in certain situations, such as for a limited time following a hospital stay when skilled care is needed to recover from an illness or injury. However, Medicare will not cover nursing home expenses for custodial care, which is assistance with daily living activities such as bathing, dressing, and eating.
Does Medicare Ever Cover Personal Care Assistance?
Medicare will cover some custodial care as part of hospice care for terminally ill beneficiaries with a life expectancy of six months or less. (Your family may renew the six-month Medicare benefit period for another six months if necessary and the physician signs off.)
Hospice care is an end-of-life care designed to provide comfort and support to individuals with terminal illnesses.
Under Medicare, hospice care includes various services, including medical care, nursing care, social services, counseling, and spiritual support. It also provides coverage for certain custodial care services, such as assistance with activities of daily living like bathing and dressing, as well as help with managing pain and other symptoms.
It’s important to note that a Medicare-approved hospice provider must provide hospice care. The beneficiary must elect to receive hospice care instead of other Medicare-covered treatments for the terminal illness. Additionally, beneficiaries must continue to pay their Medicare Part B premiums and may have to pay a copayment for certain prescription drugs and respite care services.
What Does Medicaid Cover? Who is Eligible?
Medicaid, on the other hand, is a joint federal and state program that provides health care coverage to people with limited income and resources. There are many financial Medicaid eligibility requirements.
Unlike Medicare, Medicaid services cover medical expenses, including:
- Inpatient hospital stays
- Medical costs
- Memory care areas of a skilled nursing facility
- Nursing home care coverage
- Outpatient hospital services
- Prescription drugs
- Some home health services
- Other healthcare costs
Medicaid planning is a way to legally protect your assets from payment for your long-term care. It involves carefully reviewing your assets and income to ensure you are eligible for Medicaid coverage while preserving as much of your assets as possible for your loved ones.
Medicaid eligibility is determined in North Carolina based on income and asset limits. Your income and assets must be below a certain threshold to be eligible. However, there are planning strategies that can help you meet these limits, such as transferring assets to a spouse or setting up a trust.
It is important to note that Medicaid has a look-back period of five years. This means that if you have transferred assets within the five years before applying for Medicaid, those transfers will be scrutinized and could result in a penalty period during which you will not be eligible for Medicaid coverage.
What is a Medicaid “Spend Down?” What is Medicaid “Recovery?”
Another consideration when planning for long-term care is the possibility of losing your home to Medicaid spend-downs or Medicaid recovery after death.
One way to protect your home is to use joint deeds. A joint deed is a legal document that allows two or more people to own a property together. By adding a trusted family member or friend to the deed, you can often ensure that the property will not be subject to Medicaid estate recovery after your death.
However, issues with deeds causing family members to pay capital gains taxes often cause problems when sharing home ownership. That’s why elder law attorneys often use a particular type of deed called an “enhanced life estate” or “lady bird deed.” This deed can help your family keep the homes you own in the family after you’re no longer around.
In conclusion, Medicare does cover some nursing home care in certain situations and for a limited period. However, for most long-term care needs, Medicaid is the primary source of coverage.
Medicaid planning is a way to protect your assets while ensuring that you are eligible for Medicaid coverage when you need it.
Often, using Medicaid planning trusts can prevent eligibility issues when applying for Medicaid AND remove the risk of Medicaid Recovery attaching a creditors lien on your assets after death. Joint deeds can also effectively protect your home from Medicaid spend-downs or recovery after death.
Our Experienced Elder Law and Medicaid Planning Attorneys Can Help
If you need help with elder law issues, consult our experienced elder law Medicaid planning attorneys at Hopler, Wilms, and Hanna. We can help you navigate the complex rules and regulations for long-term care coverage. 70% of adults over 65 will need long-term care at some point, so making a plan now makes sense.
Create security now by getting in touch and learning how to ensure the best assisted care for yourself and protect your legacy for your family’s future!