There are a variety of reasons a person may want to avoid going to a nursing home. One of those reasons might be the cost. According to Texas Health and Human Services, the average cost for staying in a nursing home is $3,000 - $4,000 per month. In-home care is typically going to be less, but for many people, even in-home care is economically out of reach and unaffordable.
Some people have personal savings or other liquid assets that they can use to pay for long-term care. In other cases, family members may be able to help cover the costs.
Most private health insurance plans do not cover custodial care. To the extent they cover long-term care, it is generally going to mirror Medicare coverage (see below). However, various insurance companies offer long-term care insurance. Most long-term care policies allow you to use your benefit for in-home care, hospice care, assisted living, and nursing homes. Unfortunately, even long-term care insurance can be complicated, and the coverages vary. Basically, the cost is going to be based on the coverage you get.
If it is medically necessary for you to be in a skilled nursing facility, Medicare may offer coverage. But even when Medicare does offer coverage, it is short-term and only so long as is medically necessary. For example, if you have Medicare Part A, it will pay for skilled nursing for days 1 – 20; however, from days 21 – 100, you will have to pay a portion of the cost, and after day 100, Medicare coverage ends. Medicare does not pay for custodial care. If you need ongoing (long term) help with housework or with getting dressed, Medicare is not going to provide coverage. However, Medicare will still cover your hospitalizations, doctor visits, and medical therapy. And if you have Part D coverage, Medicare will provide prescription drug coverage. You may also have eligibility for a Medicare Special Needs Plan, which would provide more affordable coverage. To get detailed information about Medicare, you can visit https://www.medicare.gov
Many Texans will need to get help from Medicaid to pay for long-term care. To qualify for Medicaid long-term care coverage, you will need to meet income and “countable” resource requirements. For example, for nursing home Medicaid, an individual cannot have more than $2,000 in countable resources (things like cash, stocks, investments, bank accounts, and non-homestead real estate). If the individual has more than $2,000 in countable assets, they will have to “spend down.” The income requirement varies each year (due to economic factors like inflation); however, as an example, in 2022, the threshold for an individual in 2022 is $2,523/month. You should know, however, that you still may be able to qualify for nursing-home Medicaid even if your income exceeds the monthly limit by using a “Qualified Income Trust.”
There are a lot of important details and variables to consider prior to applying for Medicaid. Visit Medicaid & CHIP | Texas Health and Human Services to get more information.
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