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I recently spoke at the Thirteenth Annual Elder Law Institute of the Pennsylvania Bar Institute in Hershey, Pennsylvania in July, 2010. I have spoken at the twelve previous Institutes. This year, my topic was on “Crunching the Numbers” for Pennsylvania Medicaid Eligibility. Medicaid pays for nursing home care for a large number of residents. Most couples are concerned about what assets can be protected and what happens to their income if one spouse has to enter a nursing home. Providing information on these issues is very helpful to older people and their families.
Medicare, the federally funded health insurance which you receive at 65, will only pay for skilled nursing care under certain circumstances and only for a limited period of time. Unless all of the requirements are met, Medicare will not pay. First, you must have a hospital stay of at least three days and be discharged to a Medicare-approved skilled nursing facility. Second, you must need “skilled” care for treatment of the illness or injury for which you were hospitalized. “Skilled” nursing care is care under the daily supervision of a doctor, registered nurse, physical therapist or other licensed professional. Third, the skilled care must be restorative in nature, such as physical therapy to help you to start walking after a stroke.
If all of these requirements are met, Medicare will pay 100% of the cost of care for up to twenty days. From the twenty-first day through the one hundredth day, Medicare will pay any amount due over $137.50 per day in 2010. Medigap insurance (supplemental health insurance coverage) may cover the $137.50. The co-insurance payments may increase next year. Some Medicare HMO plans may pay for the full hundred days at 100% or may have a different co-insurance payment amount. Be sure to check the Medicare HMO coverage for skilled nursing home care.
Medicare only pays as long as you require the skilled nursing care. After the one hundred days, or once you no longer require skilled care, Medicare pays nothing towards cost of the nursing home. Because of these limitations, Medicare only pays about 2% of the cost of care for nursing home residents.
Since many people may have to apply for Medicaid to cover their long term care costs, it is helpful to understand some of its rules. In Hershey, I explained how to calculate the Community Spouse Resource Allowance, which is the amount of assets that one spouse can protect when the other spouse has to enter a nursing home, as well as how to calculate the Monthly Maintenance Needs Allowance for that spouse, which is the amount of income which the person remaining at home may keep. I also taught how to calculate possible Veterans Benefits for an older disabled veteran and his wife.
There were many interesting sessions that I attended, including ones on PACE and PACENET, Pennsylvania’s Pharmaceutical Assistance Program, Retirement Planning, Medicaid Estate Recovery and a Guide to Completing the VA Application. The Institute was 2 days of non-stop education on many elder law topics and was well attended. It is something that I look forward to participating in each year.