Medicare versus Long Term Care in a Skilled Nursing Setting

With all the stress a family deals with when a loved one requires inpatient nursing and therapy services following a hospital stay, it's not surprising that things can get overwhelming.  Between the conversation with doctors and discharge planners in the hospital, to selecting a skilled nursing facility you trust to care for your loved one, there is a significant education and learning curve in what benefits are covered and what’s not.

Additionally, if your loved one doesn't make a full recovery to his/her prior functional status, other considerations must be assessed, such as what setting is most appropriate to keep them safe and how much will it cost.  Furthermore, your loved one may be resistant to these changes, which can leave you feeling guilty and at a loss on what to do next.

Medicare or Medicare Replacement Policies (managed care) are designed to cover medical needs on a short term basis only.  Most managed care policies follow Medicare guidelines, which include 100 percent coverage for skilled therapy services for day 1 through 20.  Then on the 21st day, a co-pay will be due (for Medicare that amount currently is $161.00 per day).  If you happen to carry a supplemental care policy, it will often cover this co-pay amount, however, not everyone carries this coverage.  It's not surprising then that families feel added stress as the costs mount up from out of pocket charges and co-pays while the future needs are still unclear.

A mistake many people make is in assuming that Medicare will pick up the cost on a long term basis.  Remember, Medicare covers short term medical needs of up to 100 days and that is assuming the patient continues to make progress along with other qualifiers.  When it comes to long term placement needs in a skilled nursing setting, your options are paying privately, applying for Medicaid (assuming your loved one will qualify) or, if you have a policy, long term care insurance.

What may surprise many people is the cost of living in a skilled nursing facility with 24 hour licensed nursing care is not much different, if at all, than many assisted living communities.  Combine assisted living monthly rent and the added care costs for medication management, shower/bath assistance, escort services and the prices look very similar.  Furthermore, skilled nursing facilities offer great activities for socializing at no added cost.  Ultimately, you need to look at what’s best for your loved one along with your budget and make your selection from there.

Medicare, Medicaid, Long Term Care and supplemental insurance, along with private funds are all part of the funding options that can be used to cover care in a skilled nursing setting.  They each have a place depending on whether you are looking for short-term or long-term placement and each has required qualifications.  Hopefully, you will never be in the situation where you have to make decisions about medical care or placement needs for a loved one, but, if you do, you have a little more knowledge to help get you through the process.

Editor’s Note:  By Kathleen Schuelke Chavez, Marketing & Admissions Director, Regent Care Center of San Antonio


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