Navigating Nursing Home Expenses: Understanding Medicare Coverage

Whether it’s for ourselves, our parents, or our loved ones, the prospect of long-term care can be daunting, both emotionally and financially. Nursing home expenses add up whether you need assistance with activities of daily living (ADL) or a range of medical care. The federal health insurance coverage offered under Medicare pays only certain medical nursing home expenses under very strict guidelines. On top of this, we recognize that planning for long-term care involves more than just understanding insurance policies. It requires comprehensive estate planning to ensure that your assets are protected and utilized effectively. At SCC Legal in Fairfield, NJ, our team of experienced attorneys specializes in crafting tailored estate plans that encompass provisions for long-term care coverage. In this article, we’ll take a closer look at these expenses against Medicare and how an estate plan ties into all of it. 

Deciphering New Jersey-Specific Nursing Home Expenses: A Guide to Medicare Coverage

As you probably gathered, Medicare doesn’t cover all nursing home expenses. If you need long-term care (LTC) in a nursing home, Medicare will only pay for a limited number of services and under strict circumstances. Nationwide, Medicare pays approximately 5% of all LTC expenses if it is for a restricted period and a post-hospitalization requirement. It does cover full-time skilled nursing facility care and intermittent home health care only if you need nursing or therapy care that can only be performed by medical professionals or technical personnel. 

Navigating Medicare Coverage for Nursing Home Expenses: Eligibility Insights 

To be eligible for Medicare coverage in a nursing home, you must be admitted to a nursing home following at least a 3-day hospital stay, and your nursing home admission should be within 30 days of being discharged from the hospital. You must require skilled or rehabilitative care as certified by a physician and receive it in a Medicare-approved facility.

However, you can qualify for Medicaid long-term care in a nursing home if you have income and asset limits (financial requirements) and need nursing home level care (functional requirements). Frank Campisano and the team at SCC Legal can help you navigate the enormously complex Medicaid eligibility application process in full.  

Understanding New Jersey-Specific Medicare Coverage: A Closer Look into Nursing Home Expenses

What kind of skilled nursing facility expenses will be covered by New Jersey Medicare? It will pay for you to stay in a semi-private room with meals included and the skilled nursing care you need. Also included are medications, dietary counseling, medical social services, and the medical supplies and equipment used on your behalf in the facility. Medicare will pay for physical, occupational, and speech-language pathology services if they are needed to meet your health goal.

Mastering Nursing Home Expenses: An In-Depth Guide to Medicare Coverage 

Medicare does not cover the non-medical care (custodial care) costs associated with someone helping you with activities of daily living such as using the bathroom, bathing, dressing or eating. According to Medicare, most nursing home care is custodial care. 

However, Medicare Part A (Hospital Insurance) may cover care in a certified skilled nursing facility (SNF) if it is medically necessary that you receive skilled nursing care, it is on a short-term basis, and if all the following conditions apply:

  • You have Part A and have days left to use in your benefit period.
  • You have a qualifying inpatient hospital stay.  
  • Your doctor decides you need daily skilled care from skilled nursing or therapy staff.
  • You get these skilled services in a Medicare-certified SNF.
  • Skilled services are necessary for a hospital-related medical condition. 

Do you need help with your Medicaid application? Or are you trying to plan ahead and incorporate long-term care costs into your estate plan? Either way, Frank Campisano at SCC Legal in New Jersey understands all the costs and options, and will try to get you assistance with nursing home expenses not covered by Medicare. Contact SCC Legal today for more information or visit us at:

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