Nursing Home Cost
Nursing 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|
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.