Nursing homes offer trained medical professionals that provide specialized care to people with severe illnesses or injuries.  They may specialize in short-term or acute nursing care, intermediate care, or long-term skilled nursing care.  In addition to medical care, residents are assisted with daily activities such as bathing, eating, laundry and housekeeping.

For more information on the types of nursing homes available, please visit our Types of Nursing Homes page.

This around-the-clock care comes at a price.  Nursing home fees vary widely but average about $5,000 per month.  The four main methods for paying these fees are:

• Private finances
• Health insurance
• Medicare
• Medicaid

Due to the extremely high cost of nursing home care, few people can afford to pay privately for very long.   Although it is illegal for a certified nursing home to require a resident to pay privately for any set period of time, many nursing homes give preference to applicants who can pay privately. 

Medicare’s short–term skilled nursing facility benefit is very limited, but is often helpful to gain admission to a nursing home, especially when skilled nursing care or therapy is needed after hospitalization.  Most medical insurance coverage follows Medicare guidelines.  Private insurance and Medicare pay for nursing home care only for a limited time following a hospitalization:

• You must have been hospitalized for at least 3 days.
• You must enter the nursing home within 30 days of the hospitalization.
• Only the first 20 days are 100% covered; then there is a daily deductible.
• There’s a 100-day maximum related to any one hospitalization and diagnosis.
• You must be making regular progress as documented by medical professionals.  If progress toward independence is no longer occurring, insurance coverage ends.

Medicaid

Medicaid is a joint state and federal program that will pay most nursing home costs for people with limited income and assets.  You must meet income, resources (in most cases) and other eligibility requirements.  Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients.  See the Pennsylvania Department of Public Welfare for more information.

Veterans' Benefits

The Department of Veterans Affairs may provide nursing-home care without cost to a veteran if the veteran has a service-connected disability and certain other eligibility tests are met.  Veterans who do not have a service-connected disability may also qualify for veterans’ benefits if an income test and asset test are both met.

Private Pay

About half of all nursing home residents pay nursing home costs out of their own savings -- what is sometimes called "private pay."  After these savings and other resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Medicaid.

Managed Care Plans

A managed care plan will not help pay for care unless the nursing home has a contract with the plan.  If the home is approved by your plan, learn if the plan also monitors the home for quality of nursing care.

Medicare Supplemental Insurance

This is private insurance.  It's often called Medigap because it helps pay for gaps in Medicare coverage such as deductibles and co-insurance charges.  Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare.  Some people use employer group health plans or long-term-care insurance to help cover nursing home costs.

Long-Term-Care Insurance

This is a private policy.  The benefits and costs of these plans vary widely.  Long-term care insurance can be purchased at any age after 18.  Monthly premiums are based on how old you are at the time of application, so the sooner you apply, the less your premiums will be.  Eligibility for long-term care insurance is based on your health at the time of application, so applying when you are still healthy is critical.

If you have other questions about Pennsylvania nursing home care, contact the PA nursing home neglect attorneys of Munley, Munley, & Cartwright. Our goal is to provide exceptional legal services to our clients. Our Pennsylvania elder abuse lawyers strive to achieve the highest standard of excellence for the protection of individual rights through teamwork and the use of our considerable resources and experience.

We have offices conveniently located in Scranton, Stroudsburg, Carbondale, Plains, Hazleton, Harrisburg and Hamlin. Please contact us by e-mail or telephone at (800) 318-LAW1 or contact us online.