Nursing Home Funding

Nursing Home Funding

A primary concern of many families that are searching for Nursing Home Care is how to fund it. According to Elder Options of Texas, there are several ways that nursing home care is paid for:

  • Personal Resources: About half of all nursing home residents pay nursing home costs out of their own savings. As personal resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Texas Medicaid.
     
  • Long Term Care Insurance: This is private insurance designed to cover some long-term care costs. For more information, see the section on long-term care insurance in this guide.
     
  • Medicaid: Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets. Medicaid will only pay for nursing home care provided in Medicaid-certified facilities. Bishop Davies Nursing Center is a Medicaid certified facility.
     
  • Medicare: Under certain very limited conditions, Medicare will help pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must (after a qualifying hospital stay) receive the services from a Medicare-certified skilled nursing home.

    Bishop Davies Nursing Center is a Medicate-certified skilled nursing home, and our Business Office Manager is exceptionally skilled at Medicare billing.
     

  • Medicare Supplemental Insurance: This is private insurance (often called Medigap) that pays Medicare's deductibles and co-insurances, and may cover services not covered by Medicare.

    Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. In addition, some people have nursing home costs covered, or partially covered, by managed care plans or employer benefit packages.

What does Medicare Cover?

For eligible residents needing skilled nursing care, Medicare Part A coverage will pay for a semi-private room, meals, nursing services, rehabilitation services, medications, and supplies and medical equipment for the first 20 days. From the 21st day to the 100th day, the resident will pay a daily co-insurance rate.

After 100 days, Medicare no longer pays. If a resident has coverage under Medicare Part B and is eligible for the services provided, he or she will be responsible for 20 percent of the total charges for some of the following services: occupational therapy, speech therapy and physical therapy along with medical supplies.

How is eligibility for Medicare Part A benefits determined?

  1. The resident must have a Medicare card that reads hospital insurance.
     
  2. The resident's physician must certify that the resident needs skilled care on a continuing basis.
     
  3. A minimum of three consecutive days (not counting the day of discharge) must be spent in a hospital no longer than 30 days prior to entering the skilled nursing center.
     
  4. The need for skilled care must relate to the reason for hospitalization.
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