People often ask about the cost of staying in a skilled nursing facility. First, let's take a closer look at how the system works in the state of North Da-kota.
State law requires all nursing facilities to charge both private pay and Medicaid residents, who are not in private rooms, the same rate for services based on a case mix system. Case mix is a system that is based on the intensity of care and services provided to an individual resident.
Each nursing facility has 34 case mix classifications with a corresponding rate. The rate for a resident who needs more care will be higher than for one who needs less care.
Although each facility in North Dakota has the same 34 classifications, the actual rates do vary from facility to facility.
Now, let's take a look at the various payors.
Private pay. Some residents pay for their care with their own resources. Many people have long-term care insurance that helps to supplement the cost.
Medicaid. Others qualify for Medicaid coverage. Medicaid is a program through the state of North Dakota Department of Human Services and is based on financial eligibility. Some people are able to pay for a portion of their care and Medicaid supplements the remainder of the cost.
Medicare. Medicare is a federal health insurance plan for the elderly and disabled. In order to pay for a stay in a skilled nursing facility, certain criteria must be met. The criteria include being in the hospital for at least three nights as an inpatient within the past 30 days and requiring skilled services in the nursing facility. Skilled services may include IVs, wound care, management of an unstable medical condition or rehabilitative services involving physical, occupational and/or speech therapies.
As long as skilled services are provided on a daily basis, Medicare covers the cost of the stay at 100 percent for the first 20 days and a portion of the cost for the next 80 days. Many people also have a Medicare co-insurance that pays for the remaining cost.
Medicare Advantage Plans. A few people have opted to purchase a Medicare Advantage Plan in lieu of Medicare. While the requirements of these plans follow the same guidelines as Medicare, out-of-pocket and co-pays do vary with each plan.
Commercial Insurance. Many people who are under the age of 65 and not disabled have some type of medical insurance. Some plans do have a skilled nursing benefit.
This is a brief summary of nursing home costs. For more information, please call Cheryl Coyle at ManorCare Health Services, 852-1255.
Cheryl Coyle is senior admissions director at ManorCare Health Services in Minot.