Medicare covers medically necessary, short term care in a nursing facility
Medicare does not pay for what is often called custodial care (a non-skilled service or care),, however Medicare will help pay for a short stay in a skilled nursing facility if you meet the following conditions:
You have had a hospital stay within the past 30 days in which you were an inpatient in the hospital of at least three (3) consecutive nights
You are admitted to a Medicare-certified nursing facility within 30 days of your three overnight qualifying hospital stay
You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy
If you meet all these conditions, Medicare will pay for some of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your costs. For days 21 through 100, you (or your supplemental insurance) pay the co-pay amount of $157.50 per day (in 2015), and Medicare pays any balance. You pay 100 percent of costs for each day you stay in a skilled nursing facility after day 100 or after you no longer meet “skilled care” criteria under Medicare guidelines, whichever comes first.
Most forms of insurance, such as the private health insurance or HMO you may have on your own or through your employer, follow the same general rules as Medicare with regard to paying for long-term care services. If they do cover long-term care services, it is typically only for skilled, short-term, medically necessary care.
Like Medicare, the skilled nursing stay must follow a recent hospitalization for the same or related condition and is limited to 100 days
Coverage of home care is also limited to medically necessary skilled care
Most forms of private insurance do not cover custodial or personal care services at all
Your plan may help you pay for some of the copayments or deductibles that Medicare imposes. For example, your plan may help cover the $157.50 per dayfor Medicare covered nursing home care for days 21 through 100.
Camelot is a contracted provider for inpatient services with a number of insurers including:
Blue Cross/ Blue Shield
United Health Care
Medicaid is a joint federal and state government program that helps those with low income and assets pay for some or all of their health care bills. It covers long-term care services in nursing homes, and unlike Medicare, Medicaid does pay for custodial care in a nursing facility.
To be eligible for Medicaid (known as MO HealthNet in Missouri) you must meet certain requirements, including having income and assets that do not exceed the levels used in this state. Once it is determined that you are eligible for Medicaid, the state agency will make an additional determination of whether you qualify for long-term care services and whether you will be required to pay a portion of your income (Social Security, Pension, etc.) to the nursing facility.
The Family Support Division (FSD) determines client eligibility for the MO HealthNet program, and the FSD office is the best source for information about how to qualify for Medicaid in Missouri and whether you qualify for long-term care services.
Depending on your income and savings, you may pay for long-term care services (custodial care not covered by Medicare or health insurance plan) on your own, from your private financial resources. There are also a number of additional ways you can pay privately for your long-term care including:
Long-term Care Insurance
Unlike traditional health insurance, long-term care insurance is designed to cover long-term services and supports, including custodial care in a nursing facility. Although such policies are not widely utilized, long-term care insurance policies reimburse policyholders a daily amount (up to a specified limit) for care services.