Generally speaking, Medicare will completely cover the first 20 days of being in a nursing home.  Afterwards, there is usually a co-pay of up to $161.00 per day for the next 80 days, as long as the patient is making progress.  The co-pays still average almost $5,000 per month.  Your private health insurance normally does not cover any of the nursing home costs, but occasionally a client will have an expensive health insurance plan which will cover the entire 21 to 100 days.  More often than not, you will be paying the Medicare co-pay with no private insurance coverage.

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Once you have passed your 100-day stay, you are entirely on the hook for the cost of your nursing home care.  The average private pay rate in the State of California is over $8,000 per month.  The good news is, Medi-Cal will cover a large portion, if not all, of the cost of being in a nursing home, if you qualify.  In most cases it is much less expensive to be on Medi-Cal and pay your “share of cost” than it is to pay the Medicare daily co-pay rate.

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Too many people start their Medi-Cal application after their Medicare days have ended with no assurances they can qualify.  They either end up paying a lot of money in co-pays that could have been avoided or end up holding on to a large nursing home bill.  If you have a loved one in a nursing home and are in or past your Medicare days, give us a call. We will make sure you satisfy the Medi-Cal requirements and will make your Medi-Cal application so you can avoid needlessly losing money to co-pays and private pay rates.  We can save you money and give you peace of mind during this very difficult time.