Figuring out a way to pay for long-term care in a nursing home for yourself or your parents is mind-boggling complex.
Generally, there are multiple ways to pay for nursing home:
- Private Pay.
- Long-term Care Insurance. This specialty insurance is often too costly for many. (See here and here)
- Medicaid. We have written before about the consequences to relying upon Medicaid to pay for the nursing home. (See here,here) We have previously written about the traps even trying to qualify for Medicaid to pay for long-term care. (See here,here)
- Medicare. Many people mistakenly believe their Medicare will provide payment for the nursing home. Medicare only pays for healthcare. Medicare views long-term care in a nursing home, not as healthcare, but as room-and-board. Accordingly, Medicare pays 100% for only days 1-20 of a nursing home stay, if the person was the hospital for a period before the nursing home admission; this is commonly referred to as “swing beds.” For days 21 to 100, Medicare covers all costs except for the required Medicare copayment.
I would like to highlight another partial payment option: Tricare for Life. This is a Veteran’s Benefit available to certain veterans of the United States’ Armed Forces. While Medicare generally becomes an unavailable option after day 20, TRICARE for Life covers the Medicare copayment. Practically, a person with Medicare and Tricare have 100 days of benefits.
As further discussed in this article:
Under Tricare for Life, Medicare is the primary payer and Tricare acts as a backup secondary payer. Assuming your father is enrolled in Medicare Part B and properly registered in the Defense Eligibility Enrollment Reporting System, the Tricare portion of his Tricare for Life benefit may well kick in and cover him after he exhausts his Medicare benefits for skilled nursing home care.
However, while Tricare does cover skilled nursing facility care, certain conditions apply. Tricare covers skilled nursing facility care when the beneficiary:
■ Is treated in a hospital for at least three consecutive days, not including the day of discharge, and;
■ Enters the skilled nursing facility within 30 days of hospital discharge.
Covered skilled nursing services include a semi-private room; regular nursing services; meals (including special diets); physical, occupational and speech therapy; medications provided by the facility; and necessary medical supplies and appliances. There’s no time limit as long as the care is medically necessary. Beneficiaries are responsible for applicable deductibles and cost shares.