What happens when you run out of Medicare days? Medicaid Long-Term Care Benefits Can Pay the Nursing Home if You Qualify

Skilled care in a nursing facility after a 3-day hospital admission can be covered in full by Medicare for the first 20 days, with days 21-100 covered but subject to a daily coinsurance amount. The 2024 co-insurance amount for these “Medicare days” is $204 per day and can quickly add up to $16,000 being owed to the nursing home out-of-pocket, even with Medicare coverage. You need to know whether supplemental insurance is covering your loved one’s skilled nursing facility care during these Medicare days, whether you will need to pay from your own funds, or whether Medicaid long-term care benefits will cover the bill.  

Sometimes the nursing home resident’s supplemental insurance policy (Medigap policy) covers the coinsurance amount in full for the Medicare days, but sometimes not. For various reasons nursing home residents and their families are often unaware that this coinsurance amount may be due out-of-pocket or may not know that the Medicare coverage stopped short of 100 days. Many nursing home residents do not get the full 100 days of Medicare coverage after a hospitalization.

This gap in coverage due to the coinsurance can result in an unexpectedly large bill that might need to be paid out-of-pocket in the absence of insurance or Medicaid long-term care benefits. If there is no insurance coverage, Medicaid will pay for these nursing home days if the resident is financially eligible and successfully navigates the Medicaid application process.  

Even if you believe the nursing home placement will be paid for by Medicare, you should monitor the billing very closely. If the stay is not being covered by Medicare completely, our office can provide advice about Medicaid eligibility for these days. We can let you know if Medicaid benefits will pay for the stay and advise you on what to do. There are often things you can do to arrange your assets in a way that you can qualify for Medicaid long-term care benefits. 

Contact Gerhard & Gerhard, PC today if you or a loved one needs nursing home care, even if it is expected to be short-term. We can help with the paperwork and provide the advice you need to apply for Medicaid long-term care benefits.

Disclaimer: We recommend that you receive ongoing legal advice from an elder law attorney before attempting to navigate the Medicaid application process. If you have questions or wish to secure our services, please contact us.

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