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Nursing Home: How To Pay In Texas

elder law medicaid nursing home medicaid Sep 13, 2023

This article about how to pay for nursing homes in Texas by Texas estate planning and Medicaid attorney Joy McNair and the McNair Law Group, PLLC, should not be construed as legal advice. It is for informational purposes only. For advice specific to your situation, contact us today.

As we age, there are a lot of things that we need to consider. One of the most important things is how we will manage our medical needs and support living expenses.

Nursing homes are an excellent option for older individuals who need round-the-clock medical support and care. However, paying for nursing homes can be quite challenging. For seniors who require skilled nursing services or long-term care, the cost of nursing home care in Texas can be alarming and confusing. With options including private health insurance, Medicaid, and Medicare, it can be challenging to determine what kind of nursing home care Medicare covers.

First, it is important to understand how much they cost and what payment options are available in Texas. Next, you need to know what services and benefits are available to help you pay without losing a lifetime of savings!

In this blog post, we will explore how much nursing homes cost a month in Texas and whether you have to pay for a nursing home in Texas.


How Much Do Nursing Homes Cost A Month in Texas?

The cost of nursing homes in Texas varies widely depending on their location, quality of care, and amenities. According to the Genworth 2021 Cost of Care Survey, a private nursing home room in Texas costs $7,092 per month.

However, this can range from $4,715 to $12,305 depending on where you live. The cost of nursing homes is high, so it’s essential to consider your legal options carefully.

Do You Have To Pay For A Nursing Home in Texas, Or Does Insurance Cover It?

Yes, you have to pay for a nursing home in Texas. One of the most commonly misunderstood facts is that nursing homes are not covered by Medicare unless the care is temporary or rehabilitative. The same is true for private insurance.

Payment Options for Nursing Homes in Texas

If you’re not eligible for Medicaid, several payment options are available to pay for a nursing home in Texas. Private insurance, long-term care insurance, and veterans’ benefits are available options. Another option is to use a reverse mortgage, where you can borrow against your home equity to pay for nursing home care. However, these options have specific requirements and limitations that you should discuss with us before deciding.

One payment option for nursing homes in Texas is Medicaid. Medicaid is a joint federal and state program that helps pay for medical costs. If you meet the eligibility requirements and criteria set by the state, Medicaid can cover the cost of nursing home care. However, not all nursing homes accept Medicaid, so it's important to check. Additionally, you need to become eligible for Medicaid before it can cover the cost of nursing homes.

Another payment option is long-term care insurance. Long-term care insurance is designed to cover the costs of long-term care services, including nursing homes. If you have long-term care insurance, you can use it to pay for nursing home costs. However, it's important to note that not all policies will cover nursing home costs for all types of care, and getting a policy after you need care is almost (if not completely) impossible.

Either way, if you are considering long-term care or a life insurance policy, be sure to read the policy carefully and know what is covered and what isn't.

If you own a home in Texas, you may be able to use a reverse mortgage to pay for the costs of a nursing home. A reverse mortgage allows you to borrow money against the equity in your home. You can use the proceeds to pay for nursing home care or anything else you need. However, it's important to be aware that you will eventually have to pay back the loan, which can leave you with less equity in your home.

Medicaid paysMedicaid pays

Medicaid Coverage Is The Primary Method For Nursing Home Costs: We Can Help!

Medicaid is the primary government insurance program that helps pay for nursing homes. Medicaid only covers nursing home care for eligible individuals who meet income and medical need criteria.

If you’re not eligible for Medicaid, you’ll have to pay for nursing home care out-of-pocket.

But that's where we come in - we can help ensure Medicaid services without losing a lifetime of savings!

How Long Does The Average Person Last In A Nursing Home?

The average stay for residents of nursing homes is 835 days or 2.28 years. It should be noted that this is an average, meaning some people only spend a few weeks in a nursing home, while others may live there for years. There are many cases of individuals who have spent 16 or more years in a nursing home. In most cases, the length of stay may depend on the individual's physical and cognitive health, family support, and insurance coverage.

One reason why people tend to stay in a nursing home for a shorter period than before is the rise of assisted living facility options. Assisted living facilities are designed for people who require some assistance with daily living activities but do not require nursing home care

What Qualifies A Person For A Nursing Home In Texas?

Obtaining admission to a nursing home in Texas is a relatively straightforward process. A doctor's order is usually required to begin the admission process, which is then forwarded to the nursing home. The nursing facility will assess the potential resident to determine if they meet specific criteria to be admitted to their facility. These criteria can include:

Functional abilities of the potential resident

Cognitive function assessments

Medical conditions requiring skilled nursing care

Need for physical therapy, occupational and speech therapy

Behavioral challenges that need a skilled nursing facility to be managed

Availability of vacant beds in the facility.

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Who Pays For Nursing Home Care?

Nursing home care can be expensive, and most people cannot afford it out of pocket. In Texas, there are different options for paying for nursing home care. These options include:

Private Pay: Individuals can pay for their nursing home by themselves using their personal funds, their own money, pensions, and other income or savings.

Medicare: Medicare is a health insurance program for individuals aged 65 and above. It also covers some individuals with certain disabilities. In Texas, Medicare covers a maximum of 100 days of skilled nursing care after a three-day hospital stay.

Medicaid: Medicaid is a state-federal program. In Texas, Medicaid pays for nursing home care for individuals who have exhausted their other resources. When an individual has assets over the Medicaid limit, they may seek the advice of an elder law attorney for the transfer of those assets to protect them and qualify for Medicaid.

Long-Term Care Insurance: Long-term care insurance policies vary and offer different financial protection levels in regard to length or amount of coverage. Some policies are more beneficial than others, and speaking with an insurance professional to select the appropriate policy is essential.

What Kind of Nursing Home Care Does Medicare Cover?

Medicare covers skilled nursing care services that require medical attention, rehabilitation services, and home health aide services. If you have Medicare Part A and are admitted to a skilled nursing facility following an inpatient hospital stay, Medicare will pay for the cost of the facility for the first 20 days.

From the 21st to the 100th day, Medicare will still cover the cost but expect you to pay the deductible. If you need care beyond the 100-day limit, Medicare will no longer cover the cost, and you will have to pay for it out-of-pocket or through long-term care or an insurance company.

Medicare also covers hospice care for people who are terminally ill, and their doctor has certified that they have six months or less to live. Hospice-covered benefits may include nursing care, medical equipment, medication, therapy, counseling, and social services.

On the other hand, Medicare does not cover custodial care, which is long-term care that does not require medical attention. This type of care includes assistance with daily living activities such as personal care such as bathing, dressing, and eating. If you need custodial care, you will have to pay for it out-of-pocket or through long-term care insurance.

Types of Nursing Home Costs Medicaid covers

Medicare is designed to cover medically necessary care, rather than long-term care services; however, it is possible to receive Medicare coverage for a portion of nursing home care costs.

Medicare Part A covers a stay in a hospital, hospice, or skilled nursing facility, while Medicare Part B covers doctor visits and outpatient services.

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Skilled Nursing Facilities: Medicare Coverage vs Medicaid Coverage

When it comes to skilled nursing facilities, as mentioned above, Medicare will only provide coverage within specific parameters: for individuals who require skilled nursing services or rehabilitation, which can only be accomplished in a skilled nursing home care or facility.

There are three types of nursing home costs that Medicaid covers - room, board, and medical care. Medicaid covers the majority of nursing home costs, with the government providing financial support to individuals who meet Medicaid eligibility criteria. Medicaid requires that Medicaid-approved nursing homes must provide rooms with basic qualities and essential amenities, as determined by their state's Medicaid program. Additionally, Medicaid covers most medical costs associated with nursing home care, including prescriptions, other medical supplies, equipment, and therapies.

Cost of Nursing Home Care vs. Assisted Living in Texas

In Texas, personal care costs are highly variable: they depend on the facility and level of care you need.

Nursing Home Costs

A 2021 Genworth Cost of Care survey found that the median cost of nursing home care in Texas is $5,125 for a semi-private room and $7,092 for a private room every month. This can be expensive, and many people turn to assisted living as a more cost-effective care option when they do not require round-the-clock medical attention.

Assisted living facilities

If you're looking for alternatives to nursing home care, you may consider assisted living. Assisted living is a type of long-term care that provides a more independent living arrangement than nursing homes. According to the same Genworth survey, the median cost of assisted living in Texas is $3,998 per month, which is less expensive than nursing home care.

However, the types of senior care here are not equal, so even though assisted living facilities cost less, you also get less care in most instances.

Additionally, Medicare and Medicaid do not cover assisted living costs, and you will have to pay for it out-of-pocket or through long-term care insurance.

How To Protect Assets If A Loved One Goes Into A Nursing Home

If your loved one needs care in a skilled nursing care facility, or if you are worried about out-of-pocket expenses related to long-term care, the best thing to do is contact our office. We are a skilled memory care and elder law firm that specializes in asset protection from long-term care costs, including using certain special annuities, trusts, and more.

Care Is Expensive, But We Can Help

Paying for a nursing home in Texas can be expensive, but there are options available to help you cover the costs. Medicaid and Medicare, personal income and savings, insurance, and benefits typically cover nursing home care costs. While residents of nursing homes stay 835 days or 2.28 years on average, individual factors like physical and cognitive health, family support, and insurance coverage may affect the length of a person's stay.

It's important to speak to a qualified elder law attorney and find out what options are available to you. This can help you make the best decision for yourself or a loved one in need of skilled nursing care. Remember that there is support available to you and that you're not alone in this journey - we can help!