Denise Weyer, ABA
Revenue Cycle Manager 

The decision to place a loved one or even yourself in a nursing home is never taken lightly. It can involve both emotional and financial considerations. While the quality of care and the facilities reputation are often something people think about, cost of care is undeniably their biggest concern.

If you need nursing home care in Ohio, there are several options we can assist you with, from private pay to the various insurance programs to government funded programs (dependent on your income, resources and healthcare needs). Listed below are the options available to you, and we can help navigate you through which option will work best for you.

Private Pay
A significant percentage of individuals initially pay for nursing home care out-of-pocket. This type of payment is referred to as private pay. Generally, it involves tapping into personal savings, retirement accounts, investment portfolios, and pensions. Some families choose to sell a home or other property to procure the necessary funds for a nursing home stay. Since the monthly bill can be substantial, personal resources can get depleted much faster than families anticipate. Funds paid to a nursing home are a taxable deduction.

Medicaid
This is a joint federal funding program with your state to assist lower income individuals with room and board, medical needs, and non-medical services such as the amenities mentioned above. To apply for Medicaid, you must meet the financial criteria determined by your state. Presently in Ohio, your income, if single, needs to be $10,092 per year or less. If you’re married, your income must be $15,132 per year or less. Asset limits for singles are $2,000 and $3,000 for couples. All approved medicaid residents are required to pay their income to the facility, keeping the allowed $75.00 personal needs allotment each month.

Medicare/Managed Care Insurance
These are not long term care insurances, they are health insurances that will cover a nursing home stay for a period of up to 100 benefit days. Medicare and Managed Care Health Maintenance Organization plans, also known as HMO, will pay the first 20 days of a nursing home stay in full. On day 21, Medicare and Managed Care will start paying 80%, leaving your secondary supplemental insurance responsible. If you have no other insurance, you are responsible for the remaining 20%, which is currently $217 per day. There are a few differences between Medicare and Managed Medicare. Firstly, Medicare requires a three-night hospital stay in order to utilize your benefits in a Skilled Nursing Facility, also known as a SNF. Secondly, Managed Medicare requires an authorization for SNF admission and continued insurance updates, whereby your insurance carrier determines the amount of time they are willing to pay for in a SNF. Medicare requires no authorization and no insurance updates.

Medicare Supplemental Insurance or Medigap
Private insurances such as AARP, Mutual of Omaha, and BCBS ( just to name a few) help cover deductibles, copayments, and the 20% Medicare does not cover under Part B services. A Medigap plan will also cover the 20% not covered by Medicare for days 21-100 in a SNF. Medigap Plans are secondary insurance plans designed to pay that which your primary insurance company does not pay in full.

My Care Ohio
This is a program that assists with the care of Ohio residents who are considered to be dual eligible, meaning they are eligible for both Medicare and Medicaid. My Care Ohio can pay for nursing home care, personal needs, assisted living, and even some transportation.

Veterans Benefits
Many Veterans can qualify for and receive VA LTC benefits, which include nursing home stays. The Department of Veterans Affairs also offers the VA Aid and Attendance benefits, which will offer supplemental payments for the care of a veteran or their spouse in a nursing facility, personal care facility, or at home.
Long Term Care Insurance
This is insurance specifically designed to address the costs associated with extended medical care or personal care. Policies can vary significantly in their coverage limits, qualifying conditions, and waiting periods for benefits to begin. Typically, a policy holder must be able to prove they require assistance with activities of daily living, also known as ADL, or have some form of cognitive impairment. These policies are paid directly to the insured, essentially reimbursing them for a portion of their out-of-pocket expense paid to a facility.

Hospice Respite Care
Hospice providers will pay for an established hospice patient to come to a nursing home for a period of up to five consecutive days to give caregivers a break from their responsibilities. During a respite stay in a nursing home, the patient will continue to receive the same level of care they were getting at home. In order for hospice to provide services in a SNF, they must be a Medicare approved facility. Respite stays are to be used occasionally and not as a part of the patient’s routine care.

Please reach out to our Business Office with any questions you may have or to set up an in-person appointment with me to discuss your financial options. To contact the Business Office, call 330.746.1076 ext. 186.