Reasons for Medicaid planning. Medicare or long-term care insurance benefits may be unavailable or insufficient to cover the costs of nursing home institutionalization.
While Medicare and HMOs may pay part of the nursing home care for the first 100 days, they will only pay for quote unquote skilled care, and a three-day hospitalization requirement must be fulfilled before any days of care and coverage will be allowed. The first 20 days full expenses will be paid by Medicare or Medicaid. And for the next 80 days the patient must pay a sizeable per day coinsurance amount.
Nursing homes in metropolitan areas of Florida normally charge $250.00 per day or more simply for room and board. Thus, the Medicare and HMO coverage will not pay the entire bill. Further, because of the narrow definition of skilled care, the national and Florida average for Medicare and HMO coverage is 10 to 20 days and not the full 100 days allotted. Long-term care calls for long-term money management to provide essential health and quality of life services and wears over and above that furnished by the Medicaid benefits. The burden of costs of catastrophic medical care is especially poignant in cases of married couples. Community spouses who do not plan ahead, often live in poverty to keep an ill spouse in a nursing home.
If you have any questions regarding skilled nursing care and/or Medicaid planning, please give us a call here at Waller and Mitchell at 727-847-2288.