Will Medicare Pay for Your Florida Nursing Home?

Will Medicare Pay for Your Florida Nursing Home?

Are you one of the many Florida residents relying on Medicare to pay your way if you ever need nursing home care? Depending on what you mean by "nursing home," you, your family and your pocketbook could be in for a big shock.

Many people fail to realize that Medicare does not cover long-term nursing care. Although it's common to refer to facilities that provide this kind of care as "nursing homes," these facilities really provide non-skilled, custodial care. Custodial care means help with the activities of daily life that a person cannot manage on his own, such as bathing, dressing, eating, toileting, etc. My office receives many calls each week from families who have just learned about the distinction Medicare makes between skilled care and long-term care, and find themselves facing  a staggering tide of long-term care costs. 

Most of my clients tell me their goal is to never be a burden to their children. Yet, over the past 15 years, the number of Baby Boomer children providing hands-on and/or financial assistance to a parent has tripled (US Department of Health and Human Services). If a loved one enters a custodial care nursing home, the family's tab will be $87,000 for a private room or $78,000 for a semi-private room (national averages according to the 2011 MetLife Market Survey of Long-Term Care Costs). Thus, it makes sense for you to plan ahead to deal with long-term care costs to protect yourself, your family and your assets! Your first step should be to contact our Florida Elder Law office. We can help you evaluate your situation and come up with a plan that may allow you to tap into Medicaid benefits for long-term care and/or Veterans benefits for home care, nursing home care, or assisted living. We can discuss long-term insurance policies with you, too. All of this planning must be discussed within the context of your overall estate planning goals and personal circumstances.  

Even if someone is already in a facility receiving custodial care, our attorneys can often develop a plan that can still preserve a good portion of assets. 

Now, let't talk about what Medicare will cover. Currently, Medicare Part A pays for up to100 days of skilled nursing care, per health incident. To qualify, you must

  • Be admitted to the skilled nursing facility no more than 30 days following hospitalization. 
  • The hospital stay must have been a minimum of three days. 
  • The skilled care you get must target the same condition for which you entered the hospital. 
  • The skilled nursing services must be requested by your physician, provided by a health care professional, and must be of such a nature that outpatient treatment is not possible. 

Beginning on day 21 of skilled nursing care, Medicare requires you to pay a co-payment equal to one eighth of the initial hospital deductible. If you have a Medigap policy, that will often cover the co-payment. On day 100, or at any time it is determined that you are no longer improving as a result of skilled nursing care, Medicare benefits will end.  If 90 days pass after your discharge for skilled nursing care and you are again hospitalized for a minimum of three days, Medicare will once again pick up benefits for skilled nursing care, consistent with the rules above.

Attorney Joseph S. Karp is a Florida Bar Certified and Nationally Certified Elder Law Attorney focusing on Elder Law, Probate, Estate Planning, Asset Protection, Special Needs Planning and Estate Litigation. He is AV rated by Martindale Hubbell. Mr. Karp is the founder of The Karp Law Firm, a South Florida law firm with offices in Palm Beach Gardens, Boynton Beach and St. Lucie, Florida.  Mr. Karp was named a 2011 SuperLawyer by SuperLawyer Magazine and a member of the 2011 Florida Legal Elite by Florida Trend Magazine. He is admitted to practice law in New York as well as Florida. Visit Mr. Karp's Florida Elder Law and Estate Planning website. 

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