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The Need for Nursing Home Care

When an elderly person faces a serious health issue, such as a stroke or dementia, a spouse or adult child often serves as caregiver. However, caring for someone with a severe medical condition can be physically, emotionally, and financially taxing.  For example, a wife caring for a sick husband may have her own health issues that limit her ability to render aid.  Or, for an adult child, the strain of helping an elderly parent while working a full-time job and trying to provide for her own family can quickly become overwhelming.

When the demands of caring for a loved one exceed the caregiver’s capabilities, families will need to seek professional medical assistance.  Often, the best option for someone facing a debilitating medical condition is long-term care in a skilled nursing facility. Unfortunately, however, the costs of nursing facilities can be enormous.

The Cost of Nursing Home Care

In 2022, the average cost of long-term care in a nursing facility in the Charlotte area was:

  • $7,989 per month for a semi-private room
  • $8,866 per month for a private room

On an annual basis, these numbers add up to approximately:

  • $96,000 per year for a semi-private room
  • $108,000 per year for a private room

The average length of a stay in a nursing facility is around three years.  This means that securing a private room in a nursing home in Charlotte will cost a family, on average, more than $300,000.  Of course, these figures reflect only the average amount of time someone may need to reside in a nursing home.  According to the Alzheimer’s Association, “a person with Alzheimer’s lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.” Additionally, the costs mentioned above are for 2022.  Inflation, advances in medical technology, and other demographic factors will drive the costs of nursing home care significantly higher in the near future.

Given that 35% of seniors will require a stay in a nursing facility at some point in their lives, many families face a very real possibility of confronting the stark reality of these figures.

When that time comes, many families mistakenly believe that their only choice is to hand over their hard-earned money to a nursing home at a rate of around $8,000 per month.  Unfortunately, this common misconception is the primary reason why approximately 50% of couples and 75% of single individuals will exhaust their entire life savings within a year of entering a nursing home.  In fact, many adult children end up spending their own retirement assets in order help their parents pay for the cost of long-term care.

The good news is that depleting your life savings is not your only option.

What Is Medicaid and Who Is It For?

Medicaid is a federal government program that pays for the cost of nursing home care for seniors and disabled individuals who meet certain eligibility criteria. Although Medicaid is a federal program, state law governs how the program is administered within each state.

Because Medicaid is a government benefit program, many people mistakenly believe that it exists only to help people with extremely limited income or assets. Or, to put it more bluntly, many retirees think: “Medicaid is just welfare, and welfare is for the poor.” This is absolutely false.  Do not fall into the trap of thinking that because you own a home and have saved for retirement that Medicaid is not an option. Medicaid is available to help anyone who qualifies and many people have qualified while protecting the assets they have worked so hard to attain throughout their lives.  For more information on this topic, please see the section below titled, “Myth #1: I Have Too Much Money To Consider Medicaid.”

How Do I Qualify for Medicaid in North Carolina?

Before getting into the specifics of qualification, an important disclaimer is necessary. The Medicaid eligibility rules are very complex, and much of the “advice” that people get from the internet or family is either outdated, partially correct, or worse, dead wrong. The following section explains only some of the basic legal concepts regarding how to qualify for Medicaid. It is absolutely critical to keep in mind that this article does not come close to conveying the full scope of what must be understood in order to create a proper long-term care plan. The only way to ensure that you can qualify for Medicaid while protecting as many of your assets as possible is to speak with a qualified attorney.

Medicaid imposes both financial and non-financial requirements in order to qualify for benefits in North Carolina.

Non-Financial Requirements

Applicants must be:

  • A U.S. citizen or qualified alien,
  • A resident of North Carolina, and
  • Aged 65 or older, or disabled.

Additionally, Medicaid applicants must require a “nursing home level of care,” which means that their medical needs can only be met in a skilled nursing facility.  It is important to keep in mind that skilled nursing facilities are different from assisted living facilities (a.k.a. adult care homes).  Assisted living facilities generally help residents with everyday tasks such as bathing, dressing, and using the restroom, and may include other services such as housekeeping, laundry, and social activities. Skilled nursing facilities typically offer many of the same services as assisted living centers, but also provide 24-hour medical care because residents usually have more serious health problems. While Medicaid will cover the cost of care at a skilled nursing facility, it usually does not pay for care in assisted living.

Financial Requirements

In establishing financial eligibility for Medicaid, applicants must demonstrate that both their income and assets fall within certain limits. Therefore, the distinction between what counts as income and what counts as an asset is critically important.


The income of a person qualifying for Medicaid must be less than the cost of paying for that person’s care in a nursing home. Any income that a Medicaid applicant receives or is entitled to, from any source, is counted. The most common sources of income for seniors are pension payments and Social Security Income, but may also include Veteran Administration benefits, employment wages, alimony, or IRA withdrawals.

To determine whether someone’s income falls under the threshold for Medicaid eligibility, the cost of paying for a nursing home must be established. Sometimes, the cost of a nursing facility is the “private pay rate,” which is the amount a person would need to pay if that person was using his own assets to pay for care.  For example, suppose Bob required care at an institution that would cost Bob $8,000 per month if he were to pay the facility directly out of his own pocket.  In that case, so long as Bob earned less than $8,000 per month in income, he would satisfy the income requirement to qualify for Medicaid.

However, as is usually the case with Medicaid, it’s not always that simple!  Sometimes, Medicaid does not use the “private pay rate” to determine the cost of care at a nursing facility, but instead, will use a lower amount. This lesser figure, called the “Medicaid Reimbursement Rate,” is the discounted rate Medicaid pays to the nursing facility on behalf of a qualified Medicaid recipient.  Returning to the example of Bob, Medicaid might pay for Bob’s care at the nursing facility at a discounted rate of $5,000 per month (even though Bob would have paid $8,000 for that same facility if he paid for it himself). In that case, Bob’s income would need to be less than $5,000 to qualify.

Once Medicaid starts paying for a person’s care at a nursing facility, Medicaid requires that person to contribute any future income they receive (with limited deductions) toward paying for their cost of care. The income a Medicaid recipient is required to pay is called the “Medicaid co-pay.”  So, let’s say Bob’s cost of care at a nursing home was $8,000 per month (using the private pay rate) and Bob earned $2,500 per month of income. This means that Bob’s portion of his $8,000-per-month nursing home bill is $2,500, and Medicaid pays the remaining $5,500.

Fortunately, before paying his $2,500 share of cost, Medicaid allows Bob to deduct a $30 “personal needs allowance” to pay for minor expenses (like haircuts) and certain amounts to pay for medical bills not covered by Medicaid. Let’s say that in Bob’s case, he has $170 of medical bills per month that Medicaid does not cover. Here is what this example looks like broken down into steps.

STEP 1 – Determine Income

  • Bob receives $2,500 per month in income

STEP 2 – Determine Allowable Deductions

  • Bob has $170 per month in medical expenses not covered by Medicaid.
  • Bob is allowed a $30 personal needs allowance.

STEP 3 – Determine Medicaid Co-Pay

  • Bob’s Medicaid co-pay is calculated by subtracting his allowable deductions from his income.


Income:                                                              $2,500

Personal Needs Allowance:                        -$30

Allowable medical expenses:                    -$170

Medicaid co-pay:                                            $2,300  

In this example, Bob is responsible for paying $2,300 toward his cost of nursing home care, and Medicaid will cover the remaining $5,700.

Keep in mind, however, the Medicaid co-pay only kicks in after someone qualifies for Medicaid in the first place. To get qualified, a person’s income only needs to be below the total cost of nursing home care, which might be the private pay rate or the Medicaid reimbursement rate.

If a Medicaid applicant is married, only the income of the applicant (called the “institutionalized spouse”) is counted for qualification purposes.  There are no limits on the income of the spouse who does not require nursing home care (called the “community spouse”).  Accordingly, the community spouse can have an unlimited amount of income while still qualifying the institutionalized spouse for Medicaid benefits. So, to use an extreme example, even if Bob’s wife had an income of $15,000 per month, Bob would still qualify for Medicaid.

Most community spouses, however, do not have a significant stream of income.  For the majority of people, income of the community spouse typically consists of Social Security payments, a pension, and/or IRA distributions, the sum total of which is not large enough to allow the couple to pay for the cost of nursing home care with income alone.  Usually, the community spouse’s income will be used to cover the community spouse’s financial needs.

If the community spouse’s income is below a certain level, Medicaid allows the applicant spouse to give some of his income to the community spouse. The amount of income the community spouse is entitled to is called the Minimum Monthly Maintenance Needs Allowance, or MMMNA. Medicaid uses a somewhat complicated formula for determining how much money the institutionalized spouse can “shift” to the community spouse, so you’ll want to consult with an attorney to determine that figure in your particular situation.  But to get a rough idea of how the MMMNA works, let’s return to Bob’s case.

As stated above, Bob’s income is $2,500 per month and he has a total of $200 in allowable deductions (a $30 personal needs allowance and $170 in medical expenses). Let’s say that Bob is married to Sally and that her income is $1,000 per month.   In North Carolina in 2022, the MMMNA is $2,289, which is $1,289 more than Sally’s income of $1000. Therefore, Medicaid will allow Bob to transfer to Sally $1,289 of his income in order to bring Sally’s total income up to the level of MMMNA. The amount of income Bob is able to shift to Sally is also deduced from his income for purposes of determining his Medicaid co-pay.


Income:                                                              $2,500

Personal Needs Allowance:                        -$30

Allowable medical expenses:                    -$170

MMMNA Transfer:                                        -1,288.75

Medicaid co-pay:                                            $1,011.25            


Income:                                                               $1,000

MMMNA Transfer:                                         +1,288.75

Sally’s New Income:                                       $2,289  


In this example, Sally may actually be entitled to an even greater income shift from Bob to cover her “shelter expenses,” which include things such as mortgage, real estate taxes, homeowner’s insurance, and utilities.

At this stage, it is worth repeating: the information and examples provided here are for informational purposes only.  Every person’s situation is unique.  Therefore, application of these rules to each particular situation will produce a different result.  If you need help with Medicaid planning, please set up an appointment with one of our attorneys to discuss how your family can qualify for Medicaid and save money in the process.


The rules set forth in the previous section establish how much income a person may have while qualifying for Medicaid. In addition to satisfying these income requirements, Medicaid applicants must also demonstrate that their assets fall within certain parameters.

There is a very important distinction between a person’s income and assets for purposes of Medicaid qualification. Income generally consists of a regular, ongoing stream of payments that a person is entitled to, such as Social Security payments, pensions, employee wages, and IRA distributions. Assets, on the other hand, are usually things that person owns, like a house or money in a checking or brokerage account.  Something is either an income or an asset; it cannot be both.

Broadly speaking, the assets of a person qualifying for Medicaid must not be greater than $2,000 in “countable assets.” As the name indicates, countable assets are those assets which Medicaid counts toward this $2,000 asset limit. Countable assets are distinguishable from “exempt assets,” which do not count toward the asset limit. The following chart provides some examples of countable and exempt assets.

Checking, savings, money market and other types of bank accounts Primary residence (exempt value capped in some situations)
Stocks, bonds, and mutual funds One vehicle
Deferred annuities Personal property
IRAs and other retirement accounts Life insurance with a face value of $10,000 or less
Other property (additional vehicles, boats, RVs, campers, etc.) Funeral expense trust with a face value of $15,000 or less


For example, suppose Bob owned the following assets:

  • His primary residence which has a tax value of $500,000 and has a mortgage of $100,000
  • A checking account with a value of $20,000
  • A mutual fund worth $100,000
  • An IRA worth $168,000
  • One vehicle worth $15,000

Which of Bob’s assets “count” toward his $2,000 Medicaid limit?  The checking account, the mutual fund, and the IRA, which have a total combined value of $288,000. The equity value of Bob’s primary residence and his vehicle have a total combined value of $415,000, but these are exempt assets which do not count. Therefore, because Bob’s countable assets of $288,000 are well in excess of the $2,000 Medicaid asset allowance, Bob would not qualify for Medicaid with his current mix of assets.

Does this mean that Bob, who requires a nursing home level of care, should just give up on qualifying for Medicaid and start paying $8,000 a month to a nursing home until he goes broke?  Absolutely not!  Instead, by working with a qualified attorney, Bob can create a “spend down plan” to protect some of his assets and meet the $2,000 asset limit. Be warned: spending down assets is where most people have received really terrible advice such as “you can just give all your money to your kids.” We will discuss gifts and other asset transfers in greater detail below, but for now, please understand that following this advice would likely have disastrous consequences.

If the person applying for Medicaid is married to someone who is not also qualifying for Medicaid (the community spouse), there are additional rules and considerations that must be taken into account.

For purposes of determining whether the institutionalized spouse’s assets are below the $2,000 limit, Medicaid considers the assets of both the institutionalized spouse and the community spouse.  In other words, Medicaid will add together the total assets of the couple when determining eligibility, even if only one spouse is seeking to qualify.

For example, assume that Bob’s assets are the same as above, but further assume that Bob’s wife, Sally, owns the following assets:

  • A savings account with a value of $30,000
  • An IRA account worth $80,000
  • A vehicle worth $20,000
  • A life insurance policy with a face value of $8,000

Sally’s countable assets would include her savings account, IRA, and vehicle, which have a combined total value of $130,000.  Sally’s vehicle would be a countable asset because the Medicaid rules provide that the couple may have only one vehicle that is an excluded asset.  However, because Medicaid does not impose a cap on the value of the vehicle as an excluded asset, it would be wise to list Sally’s vehicle as the excluded vehicle because it has a higher value.  Sally’s life insurance policy would also be an excluded asset because its face value is less than $10,000.  Thus, Bob and Sally’s countable and excluded assets would be as follows.


Bob’s checking account $20,000 Equity value of Bob’s primary residence $400,000
Bob’s mutual fund $100,000 Sally’s vehicle $20,000
Bob’s IRA $168,000 Sally’s life insurance $8,000
Bob’s vehicle $15,000
Sally’s savings account $30,000
Sally’s IRA $80,000
TOTAL $413,000 TOTAL 428,000


Most married couples own their homes and other assets jointly, which means both of their names are on the title and both spouses have equal economic rights in the property. For Medicaid qualification purposes, it does not matter if property is owned solely by one spouse or jointly by both spouses. Thus, if Bob and Sally jointly owned their primary residence (rather than just Bob owning it as in the example above), the result would be the same as if Bob owned it in his own name for purposes of satisfying the $2,000 asset limitation.  Please keep in mind, however, that for estate planning purposes, the manner in which property is titled could significantly affect whether Medicaid will have the ability to file a claim against the estate of an institutionalized person after their death. For more information on Medicaid estate recovery, please see the section below titled “Myth #2: If I Qualify For Medicaid, The Government Will Take My House.”

For property titled jointly with someone other than a spouse, such as an adult child, Medicaid presumes that the entire asset belongs to the applicant. For example, if Bob jointly owns a $30,000 checking account with his daughter, Medicaid will count the entire value of that checking account toward Bob’s $2,000 asset limit.

Although the countable assets of the community spouse are counted toward the institutionalized spouse’s asset limit, Medicaid allows the community spouse to retain some countable assets in excess of $2,000. The amount the community spouse is allowed to keep is called the Community Spouse Resource Allowance, or CSRA.  The purpose of the CSRA is to ensure that the community spouse is not impoverished because their spouse requires Medicaid assistance.

Once again, as with other Medicaid rules, calculating the CSRA involves yet another complicated formula! Returning to Bob and Sally as our example, here’s roughly how it works.

Step 1 – Add up the total value of both spouses’ countable assets

  • Bob and Sally’s total countable assets have a value of $413,000

Step 2 – Divide the total countable assets in half

  • Half of $413,000 is $206,500

Step 3 – Determine the CSRA

  • North Carolina recognizes a maximum CSRA of $137,000. In this scenario, one-half of the couple’s total countable assets ($206,500) exceeds the maximum CSRA ($137,000) by $69,500.  Therefore, Sally is entitled to keep $137,000, and the couple would work with an attorney to come up with a plan to spend down the $69,500 in excess funds.


  • Note that North Carolina also recognizes a minimum CSRA of $27,480. If one-half of a couple’s total countable assets falls below the minimum, then the community spouse is entitled to the minimum. For example, suppose that Bob and Sally’s total countable assets were valued at $50,000. Because one-half of $50,000 ($25,000) is below the minimum, Sally is entitled to keep the minimum amount of $27,480.


  • If one-half of a couple’s total countable assets falls between the maximum and minimum CSRA, then the community spouse is entitled to keep that amount. Therefore, if Bob and Sally’s total countable assets were $200,000, Sally would be entitled to $100,000 as her CSRA.


DISCLAIMER!!!  The rules and examples provided here are intended to give only a general familiarity with some fundamental Medicaid concepts.  No article from the internet can substitute for proper legal advice, which can only be provided by consulting with a qualified attorney.


Medicaid applicants cannot give away assets for no compensation or sell assets for less than fair market value in order reduce their countable assets.   Transfers of assets for no value or for less than fair market value are called “divestments.”  Note, however, that spouses can make unlimited transfers to each other prior to becoming eligible for Medicaid.

Medicaid will “look back” for a period of five years prior to the date of Medicaid application to determine if an applicant has made any divestments. This is commonly referred to as the Medicaid Five-Year Lookback Period. If an applicant or the applicant’s spouse have made divestments during the Lookback Period, the applicant will be ineligible for Medicaid for a period of time. This period of ineligibility is known as the Penalty Period.

How is the Penalty Period determined?  You guessed it, another formula.  Here’s how the Penalty Period is calculated:

Step 1 – Determine the Lookback Period

  • If Bob submits his Medicaid application on September 1, 2022, his Lookback Period extends back to September 1, 2017.

Step 2 – Determine the Value of any Divestments Made During the Lookback Period by Applicant or Spouse

  • Suppose Bob transferred the title to his house to his son, Dave, on July 18, 2020. At that time, Bob’s house had a tax value of $500,000 and Bob owed a mortgage of $100,000.  This would mean that Bob transferred an asset worth $400,000 to his son within the Lookback Period.

Step 3 – Divide the Value of the Divestment by the Penalty Divisor

  • The Penalty Period is determined by dividing the total value of assets transferred by something called the Penalty Divisor, which in North Caroliana, is $7,110 per month.


  • $400,000 (Value of asset transferred) ÷ $7,110 (Penalty Divisor) = 56.26 months (Penalty Period)


  • Bob would not be eligible to receive Medicaid benefits for 56.26 months (roughly 4.6 years) because he transferred his house to his son.


  • If we change the hypothetical slightly so that Bob gave his son the house on July 18, 2016, then there is no Penalty Period. Why?  Because although Bob transferred an asset to his son, he did so outside of the Five-Year Lookback Period.  There is no Penalty Period imposed for divestments which occur prior to five years before the date of Medicaid application.

This scenario—involving the transfer of a house to an adult child during the Lookback Period—is actually fairly common, and it demonstrates perfectly the dangers of attempting to plan for Medicaid qualification based on advice from friends and relatives.  For example, perhaps Bob transferred his house to his son Dave because Dave heard that Bob was allowed to have no more than $2,000 in assets to qualify for Medicaid.  The problem with Dave’s advice was that it did not account for the Lookback Period or the Penalty Period.  So, when Bob followed Dave’s advice and transferred his house, Bob was actually disqualifying himself from receiving benefits.  And the worst part?  The house was an exempt asset anyway, which meant that it did not count toward the $2,000 asset limit!  In other words, not only was transferring the house unnecessary to get Bob under the $2,000 asset limit, it actually rendered Bob ineligible for Medicaid for the next four-and-a-half years.

Our Process

If you’re feeling a bit overwhelmed by the complexity of the Medicaid qualification rules, that’s OK.  To use an analogy, if you’re air conditioning breaks, are you going to become an HVAC expert in order to fix it?  Of course not!  You’re going to hire a HVAC technician.  It’s really no different when it comes to qualifying for Medicaid.  You do not need to memorize a complicated set of Medicaid rules in order to obtain long term care for yourself of a loved one.  In fact, as discussed above, many people who have tried to “DIY” their Medicaid planning have ended up in a much worse position than if they would have gotten some help from a qualified attorney.

At Providence Wills and Trusts, our process for assisting clients with long term care planning is generally broken down into three phases.

Phase 1 – Long-Term Care Planning Session

The initial step is very simple: call our office to schedule a no cost one-hour long term care planning session.  There is no fee for this planning session.  All you need to do is complete and return our intake form ahead of the meeting with your attorney.

At your initial planning session, you and your attorney will discuss how the Medicaid rules apply to your family’s unique situation.  At the end of your planning session, you can decide if you’d like to move forward with the next step in the process.  Again, if you decide not to move forward, the initial planning session is absolutely free of charge.

Phase 2 – Create A Long-Term Care Plan

In Phase 2, your attorney will create a long-term care plan that will accomplish the following two goals: (1) achieve Medicaid qualification and (2) protect as many of your hard-earned assets as possible.  At Providence Wills and Trusts, we do not believe in a one-sized-fits-all, cookie cutter approach.  Instead, we believe that because every family’s situation is different, every family requires a long-term care plan that is tailor made to suit their needs. Not only will our attorneys create for you a customized long-term care plan, but they will meet with you to present and explain the plan in detail, and in a way that ensures that you understand it.

Phase 3 – Medicaid Application and Qualification

Once the plan has been implemented, our attorneys will prepare and submit the Medicaid application. After Medicaid receives the application, a Medicaid social worker will most likely contact our office in order to confirm the applicant’s assets, income, and other information, including transfers made during the Five-Year Lookback Period.  Because the Lookback Period extends back five years, Medicaid will require financial documents extending back at least that long.

Common Myths

Myth # 1: I Have Too Much Money To Even Consider Medicaid.

Like many Americans, you worked hard and saved in order to build a nest-egg for your retirement years.  And like many Americans, you may think that because you have built some financial stability for yourself and your family, you would not be eligible for any government assistance programs.  To demonstrate the error in this logic, let’s return to Bob.

Recall that Bob’s total assets were $415,000 and his countable assets—those assets which would otherwise render Bob ineligible to receive Medicaid—were valued at $288,000.  If Bob adopted the mindset that he had “too much” to consider Medicaid, Bob would spend $8,000 per month (which is $96,000 per year) of his own money to pay for a nursing home. At that rate, if Bob resides in a nursing home for three years, he will spend $288,000.  Assuming Bob uses his countable assets to pay his nursing home bill during this time, then he will become eligible for Medicaid at the end of this three-year period.

Bob’s countable assets:                                                                                                $288,000

Year 1 nursing home costs:                                                                          -$96,000

Year 2 nursing home costs:                                                                          -$96,000

Year 3 nursing home costs:                                                                          -$96,000

Bob’s countable assets after 3 years of paying for

nursing home care out of his own pocket:                                            $0


At this point, Bob does qualify for Medicaid because he now has no countable assets, which is below the $2,000 asset limit. Of course, the major downside of this approach is that Bob has just depleted most of his net worth.

Here is the good news: you do not have to spend through your life savings like Bob in order to pay for the cost of a nursing home.  By working with a qualified attorney, you can likely protect some of your assets AND receive the appropriate care that you or a loved-one needs.


“Myth #2: If I Qualify For Medicaid, The Government Will Take My House.” 

Although this myth is mostly false, there is some truth in it.

A primary residence is considered an exempt asset for Medicaid qualification purposes. This means that a Medicaid applicant can own their primary residence in their own name (or jointly with a spouse) while qualifying for and receiving Medicaid benefits.  Thus, if the equity value of Bob’s home is $400,000 (as in the example above), then that $400,000 value does not count toward Bob’s asset eligibility limit of $2,000.

However, if someone received Medicaid benefits during their lifetime, Medicaid has the ability to recover against the estate of that person after that person’s death.  This is known as Medicaid Estate Recovery, which allows Medicaid to recoup the value of what Medicaid has paid out of behalf of a person from their estate.

Let’s say Bob spends five years in a nursing facility prior to his death, and during that time, Medicaid pays the nursing facility $8,000 per month for Bob’s cost of care.  $8,000 per month for 60 months comes out to $480,000, which is the total amount of money that Medicaid spent on behalf of Bob during his life.  At the time of his death, Bob owns his house in his own name (because it was an exempt asset when he qualified for Medicaid), and Bob’s children now wish to inherit the house from Bob’s estate.  The problem is that Medicaid has the right to recover the $480,000 it paid for Bob’s cost of care from Bob’s estate.  If Bob’s estate includes a house valued at $400,000, Medicaid will be able to recover its $480,000 claim against the value of Bob’s house, which would leave Bob’s children with nothing to inherit.

So, while Medicaid cannot “take” your home during your lifetime, there is a chance that your home may not pass to your beneficiaries after your death because of Medicaid Estate Recovery.

Again, however, the good news is that through proper planning with an attorney, the risk of Medicaid Estate Recovery can be avoided.

Myth #3: Medicare Will Pay For The Cost of Nursing Home Care

Like Myth #2, this myth is misleading because it does contain a small ounce of truth.

Medicare is a federal health care insurance program for individuals who are over age 65 or disabled.  In general, it does not cover the cost of long-term care in a nursing home. 

However, Medicare will cover a short-term stay in a skilled nursing facility under certain circumstances.  If a senior has been admitted to a hospital for more than 72 hours and is then moved to a skilled nursing facility within 30 days of the initial hospitalization, Medicare Part A will cover up to 100 days at the nursing facility.  Additionally, Medicare only fully covers the first 20 days of skilled nursing care, which means that a stay of longer than 20 days will incur an out-of-pocket cost.

Thus, although Medicare may cover a short-term stay at a nursing facility, it will not pay for the cost of long-term care.

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