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Did you know? Medicare sometimes does pay for nursing home care

The cost of living in a skilled nursing care facility is astronomical. As we mentioned in an earlier post, New Yorkers currently pay an average of about $136,000 a year for a private room in a nursing home. Other care options do cost less but they're still not cheap: $49,200, on average, to live in a New York assisted living facility; $52,000 a year for a home health aide.

We can't control everything, unfortunately, and that means any of us could end up needing skilled nursing care 24 hours a day. Advanced planning is crucial if we want to manage the risk of astronomical nursing home bills, and that should begin with your estate plan. You can also buy long-term care insurance. Are there other options?

Most retired people receive their health insurance through Medicare. You've probably heard that Medicaid -- the federal health insurance program for the poor -- pays for skilled nursing care, but without advance planning you'll have to spend down most of your assets before you qualify for Medicaid. Shouldn't Medicare at least help pay these bills?

The fact is, Medicare does pay for skilled nursing care, but it didn't until 2013. Some long-term care planning professionals may have missed the change, which was the result of a ruling in a class-action lawsuit.

Before 2013, Medicare generally only paid for care in a skilled nursing facility if several conditions were met:

  • Within 30 days of being discharged from a hospital, you stayed in the facility for at least three consecutive days, not counting the day of discharge
  • It was medically necessary for you to receive skilled nursing care or rehabilitative services on a daily basis
  • Your condition was improving

That final condition meant that Medicare wouldn't pay for continued residence in a skilled nursing facility once your condition's improvement reached a plateau, and it was this condition that got thrown out by the courts.

So now, Medicare will pay for skilled nursing care even if your condition likely isn't going to improve -- as long as your treatment continues to be medically necessary to maintain your condition or slow its deterioration.

Even now, however, Medicare only pays a portion of the cost after 20 days. There's also no guarantee any government program will be around when you need it, so make sure you discuss your situation with an elder law attorney.

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