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Placing your loved one in a home is never an easy decision. You hope that the nursing facility you select provides the best type of care, understands your loved one’s needs and isn’t understaffed. Yet, along with these major factors, another comes into play: elder care. Whether in a home or with a home healthcare aide, elder care is extremely costly and you’ll need to deal with an insurance company during the process.

Just how much might you pay for elder care? A private room in a nursing home costs $92,378 on average and an in-home aide is about $46,332. Further, it is important to understand that you’ll first need to pay out-of-pocket costs associated with whichever policy you choose.

As you make this decision, what should you know about elder care insurance?

With Medicaid

Nurse filling out a formAfter you begin paying for care, your loved one may be eligible for Medicaid. Understand early on that not every home accepts Medicaid. Before admission, first check with the staff if they accept these policies, then make sure they have Medicaid beds available.

Additionally, out-of-pocket costs are inevitable. Your coverage usually doesn’t kick in unless you’ve paid a certain amount. Once you do, the facility will move your loved one to its Medicaid-certified section.

At this point, Medicaid still doesn’t pay the full amount for your loved one’s stay in a nursing facility. Instead, you’ll pay a portion each month and the home will bill Medicaid for the rest.

One benefit of Medicaid is that you can use it for both long- and short-term stays. However, in these instances, Medicaid expects to be compensated and may seize certain assets. However, this process isn’t so clear cut so be mindful about the following factors:

  • In order to get Medicaid coverage, your loved one should have only limited assets and may need to reduce them upfront.
  • If they transfer their assets for less than fair market value, Medicaid might not pay for your loved one’s care for a certain period.
  • For temporary stays, the state can’t put a lien on their home for payments if they have dependents there or if your loved one plans to return.
  • If your loved one passes away, the state may try to collect on the amount and go after your loved one’s estate. Even at this point, the state can’t put a lien on their home if people still live on the property.
  • If you’re a spouse footing the bill, federal law protects you from losing all assets and income to nursing care. “Spousal impoverishment” rules are then factored in to determine a patient’s Medicaid eligibility.

With Medicare

If you’re considering a long- or short-term nursing facility stay or an in-home aide, Medicare pays for all or part of your loved one’s care. However, you should keep one significant point in mind: Medicare only pays for medical care. Thus, during your loved one’s long-term stay in a facility, Medicare won’t pay for the room and board, but they’ll cover hospital care, doctor services, medications and medical supplies.

Medicare additionally pays for up to three days of medically necessary rehabilitation in a care facility. Further, following your loved one’s discharge, your policy covers up to 100 days of convalescent care, as long as the patient goes to a Medicare-certified skilled nursing facility.

For in-home care, Medicare pays for an aide up to 35 hours per week, in addition to specific treatments. These include intermittent skilled nursing care, physical, speech or occupational therapy for up to 60 days at a time. In order for Medicare to cover it, your loved one will need a physician-approved plan of care.

Long-Term Care Insurance

You also have the option of using a private insurance plan for nursing homes and in-home healthcare services. Like Medicare, policies may cover a range of choices, but in order to make sure you have the right type of coverage, keep the following in mind:

  • Understand your policy’s limitations. Certain options only include nursing homes, but more comprehensive choices further assist with adult daycare, assisted living, in-home care and medical equipment.
  • Your loved one’s pre-existing conditions may be excluded or impose a limit on their coverage.
  • Aside from pre-existing conditions, a policy might not cover certain illnesses, including Alzheimer’s, heart disease and cancer.
  • Coverage can be expensive, costing about $3,100 annually. Further, premiums regularly increase as much as 20-percent per year. Thus, it’s recommended that for lower coverage, you take out a policy in your 50s, even if you’re not ready to use to for at least 10 years.
  • Private long-term care is only financially recommended for individuals whose assets are $50,000 and above.

Once a loved one has coverage, benefits only kick in when Activities of Daily Living can no longer be performed. ADLs include bathing, eating, dressing, walking or permanent incontinence. Further, like the other two options presented here, you may need to pay a certain dollar amount out-of-pocket before your policy begins to cover the stay and care.

Even after you’ve selected a home and found optimal insurance coverage, it’s shocking to find out negligence or abuse occurred. If you suspect this is going on, understand that Trantolo & Trantolo’s lawyers are on your side. If you believe you have a claim, contact us today.