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Financial Eligibility

Nursing home care is expensive, with costs of at least $180 per day for those paying privately. If Medicare, the Department of Veterans Affairs, an insurance company or the Medical Assistance (Medicaid) program will be paying for the person's care, there are program-specific eligibility criteria that must be met.

Many seniors have Medicare Part A coverage, which may pay for up to 100 days of skilled nursing home care. However, the individual must be determined to be medically eligible for coverage at the time of admission and then at regular intervals thereafter.

Keep in mind that Medicare only pays for skilled care. It does not pay for intermediate, or custodial, care.

Individuals who have long-term care insurance will need to carefully review the policy to determine the benefit trigger, the extent of coverage and the way in which payments will be made. (Generally the two options are that the insurance will pay the home directly or the patient/family will pay the bill and be reimbursed by the insurance company.)

Veterans may be eligible for coverage of the cost of nursing home care from the VA in specific facilities.

Individuals with limited income and assets may be eligible for the Maryland Medical Assistance program if they meet both financial and medical eligibility criteria.

It is essential that the patient and family review the admission contract to make sure that the cost of care, possible sources of reimbursement and financial responsibility are clearly understood before signing the contract.