Currently, care in a nursing home costs an average of $224 per day, so it is a good idea to review all the possible payment options to determine if your loved one is eligible for any third-party coverage. If not, then paying directly for care may be the only option, unless and until your loved one becomes eligible for third-party coverage.
Some nursing home residents pay privately for care during their entire stay. Others enter covered by the Medicare program and pay privately when that coverage ends. Yet others pay privately when they are first admitted, and later become eligible for Maryland Medical Assistance when their asset level diminishes. (An individual may begin paying privately for care and, when he or she has spent down the assets to meet the financial eligibility requirements of the Medical Assistance Program, then make application for that program.)
If you plan to pay privately during any part of the stay, make sure you review the admission contract carefully and be sure you understand what is included in the daily rate and what charges are extra.
Also, remember that the extent of personal and out-of-pocket medical expenses will depend on your loved one's needs and desires.
Most freestanding nursing homes in Maryland accept Medical Assistance funding, as do some nursing homes that are part of retirement communities. To be eligible for Medical Assistance funding for nursing home care, an individual must meet medical and financial requirements.
Financial eligibility for Medical Assistance is based on one's income and assets. In the case of a married applicant, eligibility is determined by combining both spouses' income and assets.
- Income includes:
- Social Security and pension benefits
- interest from savings accounts
- investment earnings.
- Assets include:
- cash (for example, bank accounts)
- things that could be converted to cash (for example, stocks, bonds, real estate and the cash value of life insurance policies).
Tax tip: If a resident is paying for nursing home care privately, the cost is deductible as a medical expense on state and federal income tax returns. Check with your accountant or attorney for details.
Maryland Medical Assistance Application Process
Statewide, the local Department of Social Services processes all applications for the Maryland Medical Assistance Program. In Baltimore County the Towson office handles these applications. Call for an appointment.
The Legal Aid Bureau has developed a Question and Answer document to help you understand more about Medical Assistance for nursing home care.
Medicare Part A covers the cost of skilled care in a skilled nursing facility (SNF) for a limited time. Most people are medically eligible for skilled care for only a limited period of time. Eligibility for Medical Assistance varies by state. If your loved one lives outside of Maryland, check that state's requirements to learn about eligibility. The Centers for Medicare and Medicaid Services has information about each state's eligibility requirements.
The Medicare benefit covers 100 percent of the cost of skilled care for up to the first 20 days. If skilled care is still required for days 21-100 (or any portion thereof), the resident will be responsible for paying $114 per day. There is a limit of 100 days of Medicare Part A SNF coverage in each benefit period. A benefit period begins the day one goes to a hospital (or skilled nursing facility) and ends when the resident has not received any hospital or skilled nursing facility care for 60 consecutive days.
Long-Term Care Insurance
Long-term care insurance can help pay for nursing home care. This insurance may also cover the cost of in-home care, adult day care, assisted living and services provided in continuing care communities. The amount of coverage and the eligibility requirements may differ. If your loved one has a policy, read it carefully. Some policies may specify that they will pay for services only in some state-licensed facilities. If a person is in need of nursing home care now, he or she will not be able to purchase long-term care insurance.
Department of Veteran's Affairs
A veteran with a service-connected disability rated at 70 percent or more or a veteran whose service-connected disability is clinically determined to require nursing home care, may qualify for care in a VA nursing home or a nursing home that has an ongoing contract with the VA. The Department of Veteran Affairs details information about nursing home eligibility and other benefits for veterans.
There are a number of expenses a nursing home resident may incur that are not covered by any insurance. Personal expenses (such as clothing, telephone and television) and out-of-pocket medical expenses will vary depending on your loved one's wants and needs.