Helping to Pay for Nursing Home or Assisted-Living Stays

Writer / Nick Byrd
Photography Provided

In addition to being a Medicare agent for Kokomo and the surrounding area, Nick Byrd has been an occupational therapist for 26 years. He’s worked in every skilled nursing facility in the area at one time or another and is currently a rehab director at a local assisted-living facility.Medicare

One of the questions he’s often asked is, “Does Medicare pay for me to be in a nursing home?” The very complicated answer to that question is, yes and no. To get a clearer understanding of what is paid for by Medicare, you must know the difference between what is considered skilled nursing care versus custodial care. When someone is in the hospital and then they go to a skilled nursing facility, which is usually set up within a nursing home for rehab or skilled nursing care for things like intravenous care for antibiotics or wound care for open sores, then Medicare will pay for that stay. How long can you be at the facility for the care? This is where it gets complicated, and how you get your Medicare is an important part of that.

Most Medicare Advantage Plans and Original Medicare give you 100 days of skilled nursing facility coverage. Days one through 20 are covered with no copay. On day 21 you start to have copay obligations. If you have Original Medicare and a Medicare Supplement, usually the Medicare Supplement will cover your copay obligations. If you have a Medicare Advantage Plan, then on day 21 your copays become your obligations.

The amount you will be expected to pay per day varies based upon your plan, but is usually $170 to $200 per day. Please contact your agent for specific details regarding your Medicare Supplement or Medicare Advantage Plan details. If you don’t have a local agent, please feel free to contact Byrd if you have questions. If you must live in a nursing home or an assisted-living facility because you are no longer able to care for yourself, and you need help with everyday activities, then Medicare does not pay for you to live in a nursing home.

There are insurance plans available to help you recover the expenses you may incur while being in a nursing facility for skilled care, or having to live in a nursing home or an assisted-living facility because you are unable to care for yourself. Byrd carries Aetna Recovery Care Insurance, which will pay you directly up to $400 a day if you must be in a skilled nursing facility, nursing home or assisted-living facility. This gives you up to 360 days of coverage and many other options, and can be customized to meet your specific needs. You can think of this as a short-term long-term care insurance policy. The premiums are significantly less than a long-term care policy.

MedicareFor those who may have to live in a nursing home or an assisted-living facility for an extended amount of time, this can get expensive, and it can lead to your life savings and all your assets being liquidated to help pay for those costs. Long-term care insurance is available to help you protect the assets you’ve worked your entire life for and would like to leave to your family. Byrd has the Mutual of Omaha long-term care plans. These plans can be customized in multiple ways to give you the protection you need and premium you can afford.

Another way of offsetting the cost of nursing home or assisted-living costs that may be available to some is life insurance. Some life insurance plans allow you to take your death benefit early if you have a chronic condition. Please contact your agent for your plan’s details.


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How you get your Medicare matters.

Original Medicare and Supplement Medicare Advantage Plan:

-Days one through 20 covered with no copay.

-Most plans, days one through 20 covered with no co-pay.

-Days 21 through 100, usually Supplement pays copays.

-Copays vary, usually $170 to $200 daily.

-If you live in a nursing home or assisted-living facility due to not being able to care for yourself. Medicare will not pay for your stay. Short-term insurance plans are available to help with costs.


Aetna Recovery Insurance Plan

-There are three parts to it: Daily Nursing Facility, Daily Hospital Indemnity, Home Care (optional).

-Up to $400 daily.

-Up to $1,200 weekly.

-Up to 360 days.Medicare

-20 days per period; 365 days total.

-13, 26 or 52 weeks.

-Ages 50 to 89.

According to, a private room in a nursing facility is nearly $112,000 per year, and an assisted-living facility is $55,000 per year.


Long-Term Care Insurance

Mutual of Omaha

-If you max out benefits and need to go on Medicaid, you keep your assets.

-Issue age 39 to 70. Benefits non-taxable. You can get premiums returned if policy isn’t needed.

-$1,500 to $10,000 per month up to $500,000 policy limit.

-Used for nursing home, assisted living, home health care, adult day care, respite, and hospice.

-Plans are flexible and customizable to meet your needs.


Life Insurance

Many life insurance plans allow you to cash out a portion of your death benefit early in the event of a chronic condition diagnosis or a terminal illness. Check with your agent for your plan details.


Medicare Annual Enrollment Period

Medicare’s Annual Enrollment period is quickly approaching, from October 15 to December 7. This is when seniors are overwhelmed with relentless phone calls, mailers and commercials. Here are five tips to help you get through the Annual Enrollment Period and keep your sanity.

Most phones have caller ID. If you don’t know who is calling you, don’t answer your phone. If it’s important they will leave a message.

In this area there are many UAW retirees. The UAW Benefits Trust Medicare Plans are very good, so unless you also qualify for Medicaid, no plans in the area are better. However, Byrd does recommend the Traditional Care Network for those eligible. Contact your union for details on that.

Many seniors have Medicare Supplement plans that cost over $300 a month and it can be financially challenging. You may have options available. In the last Annual Enrollment Period Byrd gained six new clients who wanted to leave their Supplement and go to a Medicare Advantage Plan. He informed them that if they did not like the Advantage Plan, they had one year to return to their Supplement. As of now, no one has asked to return.

Your prescriptions can change since you’ve been on your current plan. Prescription drug plans change annually. You can never go wrong with an annual prescription drug plan review.

It’s always better to have a local agent who is available to answer questions that may come up over time. Cut Byrd’s ad out and put it on your refrigerator, or add his number to your contact list and feel free to call with any questions you may have.


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