Many people get their information about whether Medicare and Medicaid will pay for their nursing home care through the rumor mill and by speculation. Since nursing home care costs thousands of dollars a month, there is too much money at stake to rely on guesswork. There is just as much misinformation as accurate information floating around about the payment of nursing home costs by Medicare and Medicaid. To set the record straight, we will bust five myths about long-term care coverage.
Myth #1 – Medicare will pay your nursing home bill.
This is one of the most common misconceptions on the subject. It is easy to get confused about what Medicare pays for and what Medicaid covers. They are both government programs, they serve the same populations and their names are very similar.
If you paid enough money into the Social Security system for long enough, you will be eligible for Medicare. Medicare has no cap on how much income you can earn or how many assets you can own. Medicare will help pay your hospital (Part A coverage) and your outpatient care (Part B coverage), but it will not pay much toward your nursing home care. If you need short-term skilled nursing home care (convalescence) to recuperate from a qualifying injury or illness (but not a chronic condition), Medicare will pay part of your nursing home expenses for a limited number of days. Standard nursing home care gets no Medicare reimbursement.
Medicaid can help pay your cost to stay in a nursing home long-term, if you have a medical condition that requires nursing home-level of care and you meet the financial guidelines. Medicaid will not pay for you to live in a nursing home merely because you are elderly or have no one around to help take care of you.
Myth #2 – You cannot qualify for Medicaid if you own your home.
It is true that you must have limited income and assets to be eligible for Medicaid. However, Medicaid does not count certain assets, such as your home, toward your total countable assets. You do not have to be homeless or destitute to qualify for Medicaid. If your spouse continues to live in the marital home while you are in the nursing home, you can shelter some assets and income for him through a trust.
Myth #3 – You can only afford to live in a nursing home if you are rich or you bought a long-term care insurance policy.
Medicaid pays for more nursing home care than any other single payer in America. If you have a severe medical condition or significant self-care limitations and you meet the Medicaid financial guidelines, Medicaid will pay for your nursing home stay.
Myth #4 – You can give away your money and belongings to your friends and family to meet the financial guidelines for Medicaid nursing home benefits.
Medicaid will take a close look at all your financial transactions and gifts for the five years before you applied for Medicaid. They call this the “lookback period.” If they find that you gave away assets or sold them for less than fair market value, they will penalize you by making you ineligible for Medicaid for a number of months depending on how much you gave away.
Myth #5 – If you go into a nursing home, you will first have to spend your life savings and sell everything you own, including your home, which will leave your spouse with nothing.
Your elder law attorney can create a trust that protects your spouse’s assets and some income while you are in the nursing home as a Medicaid patient. Since the laws are different in every state, talk to an elder law attorney in your area.
SeniorAdvisor.com. “Busting Senior-Care Myths: Does Medicare Pay for Nursing Home Care?” (accessed December 6, 2017) https://www.senioradvisor.com/blog/2017/09/busting-senior-care-myths-does-medicare-pay-for-nursing-home-care/