What exactly does government insurance cover?


Which of these does government insurance cover:
- assisted living
- independent living
- nursing home
- hospice care

And which does it NOT cover? Thanks in advance!

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If they are in NH Medicaid program, in theory, there should be no costs involved. But Medicaid doesn't pay for personal items - like clothing, hairdresser, barber, reading materials, non standard linens, etc. So there will be those costs. Each state has a set amount that each resident keeps for their "personal needs allowance" that pays for that. Each state sets it's rate as each state manages their state Medicaid program.
The allowance runs from $ 35 - 90 a month. My mom is in TX and her rate is $ 60 a month. So if they have cable, twice a mo. beauty salon, phone, and clothing, cosmetics, etc that can easily run way above the allowance. Those things get paid out of pocket by family or the elder does without.

Keep in mind that if they go on Medicaid, there could be MERP (estate recovery) claim or lien to deal with after death.
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Anyone have thoughts on my follow up question?
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Wow, this so helpful! Thanks, Jeanne.

I guess I have another follow up question:

Do families ever face situations where they have to pay out-of-pocket? The biggest concern is when/where are the out of pocket expenses when it comes to these different types of care.
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Medicare is a typical insurance policy. You pay for it and it has a book of rules and explanations about what is covered, for how long, what the deductible is, if any, etc. If you have supplemental insurance it typically covered only the items Medicare covers and it may cover the deductible amounts. It has its own rules. Hospice is covered, and short-term rehab stays in transitional care units (which can be in hospitals, assisted living facilities, or nursing homes.)

Medicaid is not a traditional insurance policy. It is a needs-based federal program administered by the states. Once you qualify financially and medically, you are expected to pay your own way to the extent that you can. All of your income (less a small personal allowance) must go toward your care. So if you are in a long term care facility that costs $6,000 a month and you have a pension and SS checks totaling $1,000 a month, $940 goes to the facility and Medicaid picks up the rest.

(Actually, Medicaid doesn't "pick up the rest" -- it pays the facility according to Medicaid rates, which are much lower than the facility's stated rates. This is why some facilities opt to not accept Medicaid. But as far as the resident is concerned, their entire income, less a small allowance, goes to the home.)

If you are using the Medicaid program for support in your own home, the financial rules are a little different, because money is not going to a facility and you need money for your rent or room and board, etc. A needs assessment is done to determine what services are needed and can be paid for under the program. This would not be 24/7 in-home care, because at that point going to a facility would be more cost-effective for Medicaid. For example, my mother is eligible for 10 hours a week of a health aide. My husband got 32 hours a week. Other services, such as housecleaning, laundry, changing bed linens, etc. may also be deemed needed services and paid by Medicaid.

Whew! You can see that this is not a quick-answer, one-size-fits-all topic. I hope this gives enough basic information to help you anticipate what will be available to your loved ones.
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So, if my 82 yo father dies, my 78 yo mother could go into a home for Alzheimers, and the govt would cover it? She has supplemental insurance ( Blue Cross/Blue Shield) It sounds like it would not cover someone to come into her home and stay 24/7. Right?
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Thank you!

Follow up question: does government insurance cover ALL of the cost or just part of it?
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Assisted living facilities may accept Medicaid.
Independent living is not covered by insurance, as far as I know.
Nursing homes often accept Medicaid
Nursing homes that are used as transitional care units/rehab facilities are covered by Medicare for short periods of time
Hospice care is covered by Medicare

Is this what you were looking for?
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