Will Health Insurance Pay for a Nursing Home?

Watching those who have cared for you all of your life – your grandparents, parents, aunts, uncles, etc – grow older can be very hard. The elderly are often unable to do the things that they once were able to do with ease. With age, the risk for certain health conditions increases, such as arthritis, high cholesterol, high blood pressure, and more. Muscle mass decreases, eyesight deteriorates, cognitive health can decline; there are a number of complications that a person can experience as they age.

As a result of the issues that can come with age, the elderly often require extra assistance. If you have come to the realization that a loved one is no longer able to live on his or her own, despite your best efforts to provide the support that he or she needs, seeking professional help may be necessary. For many people, a nursing home may be the best option.

Costs of Nursing Home Care

nursing homeThe cost of nursing home care can vary greatly. There are a number of factors that determine the cost of care at these specialized facilities. These factors include:

  • The location of the nursing home facility, which is perhaps the largest factor that affects the cost. Care in certain states, such as New York and California, tends to be more expensive than care offered in states like Florida or Kansas; however, that’s not to say that there aren’t nursing home facilities in New York and California that aren’t affordable, or that there are facilities in Florida and Kansas that aren’t costly.
  • The size of the facility. For example, a smaller facility may cost less, as there are fewer residents and patients to care for, while larger facilities that house more residents and patients require a larger staff, more utilities, and other essentials.
  • The type of facility. Non-profit nursing homes tend to be less expensive than for-profit facilities; however, the former usually doesn’t offer as many services as the latter.
  • The type of services offered. Typically, the more services that are offered – such as health care, assistive support, and social activities – the more expensive the care will be.

In addition to all of these factors, the specific type of assistance that your elderly loved one requires will also affect the price. For example, if he or she requires round-the-clock care, it’s likely that price will be more than if your family member only needed care a few times throughout the day and could otherwise support him- or herself.

Does Health Insurance Cover Nursing Home Care?

Because the cost of nursing home care can be exorbitant, you are probably wondering if your loved one’s health insurance will help to offset the cost. It depends. There are a number of factors that will determine whether or not a health insurance policy will cover any of the costs. The type of plan your loved one has will largely determine if it will assist with the cost.

In order to find out if your family member’s health insurance will cover any of the cost, speak to a representative of the company. Ask for the specific details of the policy, and if it does include nursing home care, find out exactly what it covers. Furthermore, make sure you find out if there are specific nursing homes that you will have to work with in order for an insurance plan to be effective. Request to receive the details of the policy in writing so that you have a hard copy to refer to.

Generally, health insurance plans – including Medicare – provide coverage for rehabilitative services, but not long-term care. If, for example, your loved one has been in the hospital for a minimum of three consecutive days, and that say was medically necessary, it may be recommended that he or she attend a nursing home facility after being discharged from the hospital during recovery. In this type of case, a health insurance company or Medicare will cover a specific number of days; however, usually there are stipulations involved. For example, if your loved one does not attend a nursing home immediately following hospital discharge, medical insurance or Medicare may not pick up the bill.

The Bottom Line

If your elderly loved one requires nursing home care, there’s no doubt that you have a lot to consider; cost is likely one of the largest determining factors. If you need assistance with finding out whether or not your family member’s health insurance or Medicare coverage will assist with the cost of nursing home care, speak to a reputable insurance agent. You can also discuss the different options that are available that may provide coverage for nursing home care if your loved one’s policy or Medicare does not cover a sufficient amount of care – or any care at all.

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