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Bloomfield Office
Three Regency Drive
Bloomfield, CT 06002
Phone: (860) 242-2221
Fax: (860) 286-0185New Haven Office
1164 Townsend Avenue
2nd Floor
New Haven, CT 06512
Phone: (203) 468-4770
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PAYING FOR LONG TERM CARE 02-19-2010 One of the main problems facing today’s families is paying for long term care. Long term care is the type of help you need if you are unable to care for yourself because of a prolonged illness. A generation ago most long term care was provided by family members. Today, due to an aging population and the need of many families to have two wage-earners, long term care is generally provided outside the family, often in a nursing home. The cost of a semi-private room at facilities such as Bloomfield Convalescent Home and Wintonbury Continuing Care Center is approaching $10,000.00 per month. So how does a family pay for this care needed by a parent or other relative? Generally speaking, there are three ways in which families can pay for long-term care. They are: Medicare, Medicaid (Title XIX) and Long Term Care Insurance. This article will discuss the role of Medicare in paying for long term care. Medicaid and Long Term Care Insurance will be discussed in subsequent articles. Medicare is a Federal health insurance program. Medicare benefits are available to people who are sixty-five years of age or older, as well as to certain disabled persons. There are three parts to the Medicare program, hospital insurance (Part A); medical insurance (Part B); and prescription drug insurance (Part D). Medicare hospital insurance can help pay for inpatient care in a nursing home under the following conditions: 1. The patient must be in a Medicare-certified skilled nursing facility. 2. The admission to the skilled nursing facility must come within 30 days of a 3 day (or longer) hospital admission. 3. A doctor must certify that the patient needs skilled nursing or skilled rehabilitation services. 4. The patient must actually receive skilled nursing services 7 days per week or skilled rehabilitation services at least 5 days per week. However, even when these conditions are met, Medicare coverage for nursing home expenses is available only for a maximum of 100 days per illness. If otherwise eligible, the patient is entitled to full payment of nursing home charges for the first 20 days. For the next 80 days the patient is responsible for a coinsurance amount. At present the daily coinsurance amount is $133.50. Most Medicare supplement plans (“Medigap”) will cover this coinsurance amount. It should be noted that even if a patient initially qualifies for Medicare coverage, he is not assured of receiving the full 100 days of coverage. Medicare has become more aggressive in monitoring the progress of patients receiving this benefit. If Medicare determines that the services the patient is receiving is “custodial” rather than “skilled,” it will terminate coverage immediately. If the patient meets the eligibility requirements, Medicare will pay for: -- a semi-private room-- all meals -- regular nursing care -- drugs furnished by the facility -- blood transfusions -- medical supplies Medicare will not pay for the following services: -- extra charges for a private room -- private duty nurses -- personal convenience items -- custodial care [Care is considered custodial when it is primarily for the purpose of meeting personal needs (activities of daily living, such as providing help in walking, dressing, bathing and eating.)] While Medicare benefits for nursing home care is limited, it is, nevertheless, an important piece in the puzzle faced by many families in the 21st century. For more information, please contact Attorney Francis J. Farrelly.
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