A common question we get is, does Medicare pay for a nursing home? The Medicare program is administered jointly by the state and federal government. Medicare is available to adults 65 years of age and older, or to anyone under the age of 65 who is entitled to Social Security Disability. Medicare provides varying levels of medical coverage, depending on the plan you have. Medicare Part A and Part B, two of the more basic plans, provide coverage for hospitalization stays, rehabilitation, physical therapy, routine doctor visits, and medical equipment. Medicare Part A will also cover the cost of hospice care with a terminal diagnosis of less than 6 months.
Medicare Part B is the plan that provides for outpatient services such as short-term homecare. In order to receive Medicare homecare, the care must be ordered by a physician; the patient must be home bound and require intermittent skilled nursing or therapies; and a Medicare certified home health agency must administer the care. Medicare will provide a maximum of 28 hours of care per week, 35 with additional approval, for a limited period of time. Should you require extensive or full-time care at home, you will not qualify for Medicare services. Instead, you must either pay privately or apply for Medicaid coverage.
Similar to Medicare, Medicaid is an insurance program that is funded by the state. Medicaid covers the cost of long-term care so long as you meet the eligibility requirements. To qualify for Medicaid, you can have up to $27,216 in assets. Exempt assets include tax deferred retirement accounts and your primary residence valued at less than $893,000 (or a spouse, minor, or disabled child is living in the home). Until recently, Medicaid applicants were able to transfer their excess resources to a third party or asset protection trust to meet the eligibility requirements without incurring a transfer penalty. Recently, New York implemented a 2.5-year lookback on all transfers made to qualify for homecare Medicaid coverage. The change is set to go into effect on April 1, 2021, with a look back for all transfers occurring on or after October 1, 2020. This means that an individual applying for homecare Medicaid post-January 1, 2021, will have to submit 30 months’ worth of financial statements for eligibility purposes. To the extent there are uncompensated transfers or gifting that occurred on or after October 1, 2021, the applicant will be penalized and cannot be enrolled in homecare Medicaid during the penalty period. The hope, however, is that those needing Medicaid before January 1, 2021, will still be able to apply for homecare Medicaid without being subject to a lookback. Transfers to spouses are considered exempt transfers and are not subject to the lookback period.
It is important to meet with your Elder Law attorney to discuss the kind of care you need and whether Medicare or Medicaid is the right plan for you.