If I pay for my wife's care in a nursing home will Medicare reimburse me a percentage of the monthly cost?
This is a private care facility.
Medicare is a federal insurance program paid out of Social Security deductions. All persons 65 or older who have made Social Security contributions are entitled to the benefits, as well as persons under 65 with disabilities who have been eligible for Social Security disability benefits for at least two years, and persons of any age with end-stage renal disease.
Medicare does not pay for all medical expenses, and usually must be supplemented with private insurance ("medigap") or consumers can enroll in an HMO plan that contracts with Medicare. After 3 days of prior hospitalization, Medicare will pay up to 100% for the first 20 days of skilled nursing care. For the 21- 100 days, the patient will pay a co-payment. The premiums and copayments are increased every year. There will be no Medicare coverage for nursing home care beyond 100 days in any single benefit period.
It should be noted that Medicare only pays for “skilled nursing care,” does not pay for “custodial care” and the average stay in a nursing home under Medicare is usually less than 24 days. Thus, few can look to Medicare to pay for any substantial nursing home costs.
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Unfortunately, no, Medicare does not pay for long term care in a nursing home. Only your own money or if you and she can qualify will Medicaid pay for your wife's nursing home care. Your state is an income cap state, you if your income is too high, regardless of the assets you have, you still may not qualify for Medicaid. Contact and elderlaw attorney in your State for more advice on Medicaid planning.
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Without understanding your plans or financial situation completely, I’ll explain the rules and give guidance of where to turn to for specific answers on your situation. Medicare Part A only covers skilled care given in a certified nursing facility for individuals who meet certain conditions. Medicare doesn't cover all services. In most cases it doesn't cover long-term care stays in a nursing home. The services that Medicare doesn't cover, you'll have to pay out of pocket for them, unless you have other insurance or a Medicare health plan that covers those services. You may still have to pay your deductible, coinsurance, and co-payments. To sum it up… you may still have out-of-pocket expenses each month.
Remember that Medicare is based on 3 main factors:
1) Federal and state laws.
2) National coverage decisions made by Medicare about whether something is covered.
3) Local coverage decisions made by companies in each state that process claims for Medicare.
a. These companies decide whether something is medically necessary and should be covered in their area.
It’s almost impossible for one to know and understand each state’s rules and regulations as well as reimbursements that might be covered by each individual plan, so I recommend that you talk to your State Health Insurance Program (SHIP). Contact information is available at the “Contacts” link on the Medicare Website
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