MO_ElderLawGroup_Header.png

News

Announcements & Updates

 

Five Ways to Pay for Nursing Home Care

The average cost of a nursing home in Missouri is more than $6,000.00 per month.  In light of the ever-increasing cost of nursing home care, many seniors are asking how they may pay for that nursing home care.  When someone enters a nursing home, there are several ways that person can pay for the nursing home: 

  1. PRIVATE PAY (OUT OF POCKET);

  2. LONG-TERM CARE INSURANCE (LTC);

  3. MEDICARE (WHICH ONLY PAYS BETWEEN 20 DAYS TO 100 DAYS AND COULD PAY LESS DEPENDING ON THE CIRCUMSTANCES SURROUNDING YOUR ADMITTANCE INTO THE NURSING HOME AND YOUR MEDICARE SUPPLEMENTS);

  4. VETERANS BENEFITS (WHICH USUALLY DO NOT COVER THE ENTIRE COST OF A NURSING HOME); AND

  5. MEDICAID


Questions About paying for Nursing Home Care?

1. Private Pay

Private pay means paying the costs each month out of private funds, such as savings accounts or retirement accounts. If a person chooses to private pay for nursing home care, their assets are not subject to review by the nursing home or by a governmental entity such as Medicaid or the Veteran’s Administration (VA). 

2. Long-Term Care Insurance

Long-Term Care Insurance (LTC insurance) is coverage that provides funds for the cost of nursing-home care, assisted living, home-health care for individuals.  The terms of the individual LTC policy will determine the terms, services covered, time-period covered, and amount of coverage available to the insured person under the policy. LTC insurance is typically purchased through a financial advisor well in advance of needing nursing home care. The cost of a LTC insurance policy varies based on the terms of the policy, services covered, age of the insured person, health of the insured person, etc.

3. Medicare

Medicare is an insurance program for adults 65 years old and over and for certain individuals with serious disabilities.  Medicare is available regardless of an individual’s income or assets.  However, Medicare (and Medicare supplement plans) provide limited coverage for long-term nursing home care.   

4. Veterans Administration Benefits

War-time veterans may be eligible for VA assistance to help cover nursing home costs.  However, it is important to note the available VA benefits have resource (asset) restrictions, and oftentimes do not cover the entire cost of the nursing home.

5. Medicaid

Medicaid is federal and state program, which should not be confused with Medicare. Unlike Medicare, each state has its own unique Medicaid rules. This article discusses Missouri’s Vendor Medicaid program, which provides Medicaid coverage for nursing home costs. If you live in a state other than Missouri or have questions about a Medicaid program other than Vendor (nursing home) Medicaid, please consult an experienced elder law attorney in your area.

The Vendor Medicaid rules are complex and any individual seeking to qualify for Vendor (nursing home) Medicaid should speak to an experienced elder law attorney before completing the Vendor Medicaid application. An elder law attorney can help you navigate the Vendor Medicaid rules to save assets. To obtain Vendor Medicaid coverage you must (1) need the kind of care a nursing home provides, and (2) be financially eligible.  Whether the individual requires the kind of care a nursing home provides requires a medical opinion. 

To be financially eligible, a single, unmarried individual must have less than $5,000 in countable assets.  Certain assets are exempt and therefore, not included as a “countable asset.”  For example, the family home, one vehicle, furniture and household items, and term life insurance are all exempt (non-countable) assets.   

The rules of financially eligibility for a married individual are more complex.  When an applicant is married, both spouses’ income and assets are considered regardless of any premarital agreements, such as a pre-nup, and regardless of how those assets are titled.  The spouse remaining at home may keep half of the countable assets up to the maximum exempt asset allowance established by federal law.

Once an individual is deemed eligible for Vendor Medicaid coverage, he or she will be required to pay a “surplus” amount each month to the nursing home.  The surplus amount is calculated based on the individual’s monthly income.  The individual is allowed to pay health insurance premiums and keep $50.00 per month for personal needs.  The individual’s remaining income is due each month to the nursing home, with some exceptions. For Missouri’s Vendor (nursing home) Medicaid, there is no income “cap” to qualify for Vendor Medicaid.

The information above is a basic overview of the rules for Vendor Medicaid.  The reality is the rules for Vendor Medicaid coverage can be complex, ever changing, and difficult to understand.  There may be strategies and tools available to allow nursing home Medicaid applicants to preserve assets while becoming eligible for Vendor Medicaid. It is never too late to start Medicaid planning, as there may be some tools available in a crisis situation.  Consulting an experienced elder law attorney is the best way to decide which strategies work best for your situation. 

The attorneys at The Elder Law Group are experienced in MEDICAID ASSET PROTECTION and can meet with you and your family to tailor a plan that makes sense for you and your loved ones. Contact us today at 417-708-2044 or at info@TheElderLawGroup.com to schedule a consultation.

The information in this blog post is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this blog post should be construed as legal advice. No reader of this post should act or refrain from acting on the basis of any information included in this blog post without seeking the  appropriate legal or other professional advice on the particular facts and circumstances at issue.

 

marcus grisham