Making the decision to move from your home into a facility is one of the most challenging decisions to make. Here are some things to consider:
Medicare vs Medicaid
Medicare covers short-term nursing home stays following hospitalization, but generally does not cover long-term care stays in a nursing home.
Medicaid covers long-term nursing home stays, and may include coverage of home- and community-based services (HCBS) for a variety of groups, including people with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities.
It is important to remember than not all nursing homes are certified to participate in Medicare or Medicaid. Please refer to pages 47-52 in the Centers for Medicare and Medicaid Services PDF: Your Guide to Choosing a Nursing Home or Other Long-Term Care for more information on programs that protect nursing home residents.
Where to get Help
There are several state and federal programs that you can turn to for long-term care services and supports. These include:
Steps to Choosing a Nursing Home
Step 1: Find nursing homes in your area.
Step 2: Compare the quality of the nursing homes you are considering.
Step 3: Visiting the nursing homes you are interested in or have someone visit for you.
Step 4: Choose the nursing home that meets your needs.
For more information, refer to pages 17-36 in the Centers for Medicare and Medicaid Services PDF: Your Guide to Choosing a Nursing Home or Other Long-Term Care.
Paying for Nursing Home and Other Costs
Nursing home and other long-term care options can be costly. There are a variety of ways you can pay for nursing home care and long-term care, which can include: personal resources, help from your state, long-term care insurance, and Medicare.
You can use your personal money and savings to pay for nursing home and long-term care services. Some insurance companies allow you to use your life insurance policy to pay for long-term care. Ask your insurance agent how this works. Be sure to get help before using either of these options. There are important issues you need to understand.
Help from your State (Medicaid)
- Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Most health care costs are covered if you qualify for both Medicare and Medicaid. Most, but not all, nursing homes accept Medicaid payment. even if you pay out-of-pocket or with long-term care insurance, you eventually may "spend down" your assets while you are at the nursing home, so it is good to know whether the home will accept Medicaid.
- For more information on Medicaid eligibility in your state, call the local Medicaid office.
Long-Term Care Insurance
- This type of private insurance policy can help pay for many types of long-term care, including both skilled and non-skilled. Long-term care insurance can vary widely. Some policies may cover only nursing home care, while others may include coverage for a whole range of services, like adult day care, assisted living, medical equipment, and informal home care.
- Things to look out for:
- If you have long-term care insurance, check your policy or call the insurance company to find out if the care you need is covered.
- If shopping, find out which types of long-term care services and facilities the different policies cover.
- See if a pre-existing condition may limit your coverage.
- Buy from a reliable company that is licensed in your state.
- Federal employees, members of the uniformed services, retirees, their spouses, and other qualified relatives may be able to buy at discounted group rates. Visit: https://www.opm.gov/healthcare-insurance/long-term-care/