' Nursing Home Cost

Nursing Home Cost

Elderly woman assessing her Nursing Home CostNursing home cost is highly dependent upon the circumstances of an admission, particularly whether care is needed on a short-term or long-term basis.

While short-term care is almost always covered by Medicare for those who are eligible to receive benefits, long-term care requires alternative payment methods and the costs can be very expensive.

Other factors influencing nursing home costs include the geographic location of the facility and whether a patient has a private or semi-private room.

Short-Term Care & Medicare

Skilled care, provided by nursing homes (or skilled nursing facilities), is often needed on a short-term basis by seniors who have been hospitalized due to illness or injury. Medicare provides coverage for skilled care on a short-term basis when the following criteria are met:

  • A senior is currently receiving Medicare Part A (Hospital insurance) benefits and is therefore 65 years or older or has been formally diagnosed with renal failure.
  • A hospital stay of three or more consecutive days (three midnights) within the past 30 days.
  • A physician has determined that skilled care and/or rehabilitation is medically necessary due to a current health condition.
  • The skilled services required are provided in a facility that has been certified by Medicare.

If all of these conditions are met, Medicare will contribute to the nursing home cost required on a short-term basis (for up to 100 days). Specifically, Medicare will provide 100% coverage for skilled nursing costs for the first 20 days of a nursing home stay. From day 21 through day 100 of the benefit period, the patient is responsible for paying approximately $130 per day.

Long-Term Care & Alternative Payment Methods

A benefit period ends when skilled care or rehabilitation has not been provided by the nursing home for 60 days. In such cases, Medicare no longer covers nursing home costs unless a patient experiences another qualifying hospital stay. Nursing home care provided from this point on is typically considered long-term care and patients must rely on other types of insurance coverage or pay privately.

Other payment types include long-term care insurance (which does not cover pre-existing conditions), Medigap policies and/or veteran’s benefits. Those who pay privately will commonly spend down their assets to qualify for Medicaid, a state-administered program for low-income individuals or families.

Nursing Home Costs By State

Nursing home costs vary depending on geographic location and whether a patient receives care in a private or semi-private room. According to a 2011 MetLife Market Survey of Long-Term Care Costs, the nationwide average daily rate for care provided in a private room was $239 and, in a semi-private room, $214.

Here is a breakdown of average daily nursing home costs across the United States:

State Semi-Private Room Private Room
Alabama $176 $186
Alaska $678 $655
Arizona $182 $233
Arkansas $140 $164
California $235 $301
Colorado $207 $227
Connecticut $362 $394
Delaware $239 $259
Florida $223 $256
Georgia $167 $179
Hawaii $330 $373
Idaho $199 $212
Illinois $175 $219
Indiana $177 $234
Iowa $156 $166
Kansas $147 $166
Kentucky $190 $213
Louisiana $138 $145
Maine $257 $280
Maryland $248 $276
Massachusetts $327 $350
Michigan $220 $236
Minnesota $184 $205
Mississippi $190 $195
Missouri $141 $160
Montana $180 $193
Nebraska $163 $178
Nevada $206 $237
New Hampshire $276 $309
New Jersey $286 $316
New Mexico $189 $216
New York $344 $358
North Carolina $194 $217
North Dakota $161 $175
Ohio $199 $223
Oklahoma $133 $172
Oregon $228 $253
Pennsylvania $254 $270
Rhode Island $254 $280
South Carolina $176 $196
South Dakota $179 $194
Tennessee $174 $191
Texas $139 $188
Utah $165 $211
Vermont $252 $279
Virginia $201 $217
Washington $240 $263
Washington DC $299 $315
West Virginia $229 $238
Wisconsin $224 $245
Wyoming $193 $212

Additional costs incurred during a nursing home stay may include supplies such as incontinence products, transportation to medical appointments and nutritional supplements if requested by the patient or family members.

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Written by gerontologist Sara Shelton.

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