Lakes Region team
When it’s time to go to a nursing care center, the No. 1 question we get is, “How will I pay for this?” There are a few different options, and it is dependent on what type of stay you are planning.
This is often referred to as a skilled stay or rehab stay. In most cases, you are at the hospital and in need of physical, occupational and/or speech therapies for a short period of time before returning home. For a short-term stay, Medicare, Medicare Part C, Medicaid or Private Pay will cover the expenses.
- Medicare pays for up to 100 days. It will pay the first 20 days in full, and then you will have a daily co-insurance for days 21-100. Many options are available for a secondary insurance to pay for the co-insurance.
- Medicare Part C (insurance policy that replaces your Medicare) or commercial insurance: The facility will need to obtain authorization from that insurance prior to admission. They will also send updates on your progress to that insurance upon request. The insurance company will dictate the length of stay and determine when you are ready to go home. It is advised to research the out-of-pocket costs associated with skilled nursing with your insurance company prior to your stay.
- Medicaid will cover your stay in the facility for both short-term and long-term care. The out-of-pocket cost will never be more than your monthly income. If you have a community waiver from Medicaid, you will be allowed 90 days in skilled care before you are required to pay your income to the facility. This allows you to maintain your house in the community while you get the therapy you need to return home.
- Private Pay: This will only come into play if your insurance denies your stay and you do not qualify for Medicaid. You will want to talk to the admissions department to discuss the cost.
When you need a more permanent stay, we refer to this as long-term care. When this happens, you will move into the facility with no plan of returning home.
For long-term care, your Medicare and insurance will most likely not pay for your care. You will usually need to be a Private Pay or Medicaid patient.
- Private Pay is when you pay for all expenses out-of-pocket. Different types of long-term care insurance are available to reimburse you for a portion of the daily cost. These pay about $100 per day. You would be responsible for the difference between this and the actual private rate the facility charges you.
- Medicaid will pay for the entire monthly cost, minus your income. If you qualify for Medicaid, your long-term stay will be covered. You will receive a monthly Patient Needs Allowance (currently it is $50 per month) out of your income, and the remainder will go to the facility. Medicaid will make up the difference between what you make and what the facility costs.