Long Term Care: Medicare and Simena Bill


The need for long-term care for a family member is often unexpected and finding the right options can be overwhelming. Especially when trying to determine cost and coverage from Medicare.

Long term care in a semi-private nursing home on average costs $6,327 a month without coverage(1). While Medicare can lower these costs, patients first have to qualify by having all three of the following:

An inpatient hospital admission of at least three days
Admittance to a Medicare-certified nursing facility within 30 days of that inpatient hospital stay
A need for skilled care, such as skilled nursing services, physical therapy, or other types of therapy

After a patient qualifies, Medicare covers 100% of costs for the first 20 days. From days 21 to 100, coverage requires a $164.50 daily copayment from the patient. This could amount to over $13,000 in out of pocket costs for patients and family.

In 2019, Arizona Senator Kyrsten Sinema passed the bipartisan Homecare for Seniors Act as a way to alleviate medical costs for seniors by allowing the use of Health Savings Accounts (HSA) to cover medical expenses. This includes home care. However, this benefit is limited only to those who have been paying towards their HSA long enough to cover home care, and still leaves those needing specialty nursing facility care with no option to utilize their HSA.

To avoid the financial burdens of long term care, many families chose the alternative of taking care of aging loved ones themselves. An estimated two out of three long term care patients are cared for by family(2). Not only does this potentially lead to loss of income for the family member, long term care often requires aid that many family caregivers are not equipped to provide, as well as caregiver burnout.

With the growing demand for long term care due to increasing life expectancies, many are beginning to realize the importance of financing options. Washington state has already begun working on a solution by passing a bill that allows for public funds to supplement long term care needs(3). With such an innovative policy in place, we may see other states soon follow suit.

Call our Care by Design team at 602-285-1800 to discuss options for your own long-term care planning need.

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