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Medicare/Medicaid Benefits

Medicaid Nursing Home Care

Medicare will cover some skilled nursing home stays. However, in order for the beneficiary to be covered under Medicare, they must meet the following criteria:

The care must be provided by a "skilled nursing facility"
The care must be received within 30 days of a hospital stay of at least 3 days
The individual must need continuous care
A physician must prescribe the care.

Medicare will pay for the first 20 days of care 100%. From the 21st day through Day 100 the beneficiary must pay $96.00 per day (that means you), for a stay over 100 days in duration, the individual pays the full cost themselves. Do not expect much in the way of long-term care from Medicare.

Medicare and Home Care

Medicare will cover home care visits to treat an injury or illness. To receive this type of care, the person must be under a doctor's care and must be confined to their home. Also, Medicare will not pay for intermediate and custodial in-home care. That means it may not cover cleaning and meal preparation costs.

How are people paying for the costs of long term care?

Many families receive assistance from the state to cover the cost of long-term care. Essentially the family must become impoverished to qualify. In Colorado, a caseworker would review the value of all cash and assets and determine whether you qualify for aid. If your assets exceed $3,000 per couple, you have to use any excess funds or assets to pay for nursing home care.

In most cases families have to spend down their cash or assets to meet Medicaid criteria. That means selling assets in your estate to pay for long-term care. Each county in Colorado can provide you with a list of the criteria an individual must meet in order to qualify for Medicaid nursing home assistance. The asset and income limits will rise a little with the cost of living.

As of 1999, the asset limit for an individual is $2,000 and $3,000 for a couple.
Also, Medicaid has income limits. It ranges from $1,500 to $3,035. Any amount of income over $1,500 must be put in a trust and used for nursing home expenses.
If you are married, the spouse still living in the community may qualify for the Community Impoverished Spouse Program. The Impoverished Spouse Program allows for resources and income to be diverted to the spouse at home to maintain their standard of living. As long as the spouse is in the home, the house and car are exempt assets.

What this means is that the institutionalized person's spouse can stay in the home, have a car and can have an income. However, once the spouse who lives at home dies, the state may put a lien on the property to recover nursing home care costs.

Should you plan on nursing home assistance from the state of Colorado?

Once you have a chance to review how Medicaid nursing home benefits are provided, you have to determine how this would impact you or your children. If you have income and assets, do you want to use it to pay for nursing home care or do you want to leave some portion of it to family members?

If your estate is very small and you have little income, you may not be able to afford a long-term policy. However, if you have an estate of some value and a monthly retirement income, you may want to purchase a long-term care policy as part of estate planning.

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