So, the patient is in a skilled care facility, what’s next? Most nursing home stays begin with at least a three day hospitalization. Then the patient is discharged to a skilled care facility for some sort of skilled care such as physical, occupational, or speech therapy. This therapy is covered by the patient’s health insurance (Medicare) for a short period of time up to 100 days per benefit period. A great resource for understanding Medicare is the “Medicare and You” handbook published annually and mailed to all Medicare enrollees. A free copy in .pdf format is available here: www.Medicare.gov/Publications.
Medicare is health insurance. Everyone who has paid into the system and who qualifies (e.g., is over the age of 65, or who has been blind or disabled for at least 24 months) is entitled to Medicare. Medicare covers hospitalization, doctors’ visits, medical equipment and the like. Medicare deductibles and co-pays are often covered by a supplemental policy known as a Medigap policy.
After Medicare coverage ends, the patient must pay from income, long-term care insurance, savings, Medicaid, or some combination of these resources. Folks often confuse Medicare and Medicaid. Medicare, like any health insurance policy, does not have an income or asset limit. Medicaid pays for healthcare if a person meets certain financial and medical requirements.
In our community the average cost of non-skilled nursing home care is about $5500 per month. This does not include medicines. Some patients improve or “rehab” so that they may return home or to an assisted living facility. The skilled care may continue through home healthcare. Home healthcare is covered by Medicare as long as the person is “homebound,” needs the care to maintain or improve his level of functioning and the doctor continues to order the care. This is a wonderful benefit to help support a patient’s continued rehabilitation and functionality. In my next blog, I will address how patients who must stay in the nursing home pay for continuing care.