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Medicare and Medicaid to Fund Nursing Home Rehabilitation and Long Term Care

Posted on: November 15th, 2019 by Lawrence A. Friedman

Medicare is a federal government program to provide health care for most people who are age 65 or older, totally and permanently disabled so that they can’t work, or have ALS (Lou Gehrig’s Disease) or end stage renal failure.  While Medicare can provide broad coverage for doctor and other health professional fees, surgeries, medicines, therapies, and hospitalization, Medicare is less helpful when it comes to nursing home charges.

Medicare does cover the full cost of rehabilitation in a nursing home after 3 days of hospital admission for up to 20 days.  Medicare also can cover part of the cost of rehabilitation in a nursing home for up to another 80 days, but patient co-payments can be required as well.  Note that while Medicare can pay toward up to 100 days of a particular rehabilitation, 100 days is a maximum/ not guarantied coverage period.  Medicare rehabilitation coverage can end well short of 100 days (and even after less than 20 days) where rehabilitation is not medically necessary to achieve further recovery or avoid decline or where the patient refuses to participate in rehabilitation.

Medicare does not cover any of the cost of long term care other than limited therapies.  Therefore, long term care residents of nursing homes and assisted living facilities must fund care privately or turn to Medicaid.

To qualify for Medicaid, both assets and income must be within Medicaid caps, and usually both spouses’ finances come into play.  Because Medicaid financial caps are quite low, families often exhaust savings on care costs unless they protect assets through long term care Medicaid planning.

Families have no obligation to work with a lawyer, but because qualification rules are complex and often counter intuitive, do it yourself Medicaid planning never is a good idea.  Poor planning can be ineffective or, worse, result in Medicaid penalties and ineligibility.  Consequently, we almost always find that retaining FriedmanLaw for Medicaid planning and Medicaid applications normally saves far more than our (not insubstantial) fees.

Further information on Medicare, Medicaid, and long term care is available throughout this website SpecialNeedsNJ.com.

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