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Out-of-Pocket Expenses

Whether one pays for nursing home care privately or meets the criteria for payment by Medicare, long-term care insurance, Medicaid, or through the Department of Veterans Affairs, there will still be certain expenses that will not be covered and for which the resident will be responsible. Nursing homes must provide residents with a list of the items the facility does not supply as part of the daily/monthly rate. Of course, the resident is responsible for any personal items he or she needs such as clothing, snack items, cigarettes, and the like.

Other out-of-pocket expenses include, but are not limited to, the following:

  • Beauty/barber shop charges
  • Television rental (if you do not bring your own)
  • Telephone service
  • Newspaper service
  • Private ambulance transportation (if not deemed medically necessary by a physician)
  • Hearings aids
  • Dentures
  • Eyeglasses

Medical and Medicare

If the Medical Assistance program pays for a resident's care, the following items will be covered. Private pay residents will be charged directly for these items:

  • Incontinence pads or briefs
  • Laundry services

Health insurance (including Medicare and Medical Assistance) may pay part or all of the following. If there is a co-pay amount that is not covered by a Medigap policy (a health insurance plan that fills the gaps in original Medicare plan coverage) the resident will be responsible for the co-pay amount.

  • Medications
  • Lab work
  • X-rays
  • Physicians' bills
  • Medical equipment rentals (for example, a wheelchair)
  • Oxygen and related supplies
  • Specialty medical equipment (for example, an air mattress, Clinitron® bed, suction machine – unless medically authorized)
  • Respiratory therapy