Between Medicare and Medicaid, Medicaid tends to be the main government benefits program of note when it comes to nursing home care costs, as Medicaid covers long nursing home stays for eligible seniors, whereas Medicare generally does not. However, Medicare still sometimes ends up playing a big role when it comes to a senior's efforts to pay for nursing home care, as this government program does provide up to 100 days of coverage for certain nursing home care for eligible seniors.
Medicaid and Medicare rules regarding nursing home care coverage are very complex. The specifics of these rules can have impacts on many things.
For one, they can potentially affect the behavior of nursing homes. Some are concerned that the Medicare rules regarding payments to nursing homes for nursing home care are impacting the amount of therapy nursing homes are providing patients.
Under current rules, one of the big things that affects how much Medicare will pay a nursing home for a Medicare beneficiary's nursing home care is how much therapy the nursing home gives the patient per week. Generally speaking, nursing home care that is classified as "ultra-high" therapy-wise (720 or more hours of therapy per week) tends to command the highest per-day Medicare payment rates for nursing home care.
Over the past decade or so, there has been a big spike in "ultra-high" amounts of therapy being given to Medicare beneficiaries at nursing homes. Some claim this increase is occurring because the above-mentioned payment rules can give nursing homes a financial incentive to give Medicare beneficiaries higher amounts of therapy, regardless of the beneficiaries' individual needs. Do you think Medicare payment rules are impacting therapy levels at nursing homes?
Other things the rules and regulations regarding government programs like Medicare and Medicaid can impact include what it takes for a senior to qualify for benefits under the programs, what financial impacts getting to qualifying status under the programs can have for an elderly individual and what sorts of tactics be can used to plan and prepare for benefit eligibility issues. Consequently, these rules can be a very important thing to factor into long-term care planning. Thus, seniors may find it helpful to speak to an attorney with extensive knowledge of these rules when working on coming up with a plan regarding long-term care within their estate plan.