As your spouse or parent gets older, they may need to move into a nursing home to receive the care they need. Nursing home care can be expensive, and it's important to know how you can pay for it without going broke. In many cases, you can get nursing home care for less than their social security income. The way to do that is to successfully navigate the Medicaid process. Once your parent is approved for Medicaid, their cost of care will be no more than their income, and in many cases much lower for married couples. Let's take a look at the details.
Your Parent's Social Security
If you have an aging parent who needs nursing home care, you may be wondering how they will be able to afford it. Nursing home care is very expensive, especially for a parent on a fixed income. However, there is help available in the form of the Texas nursing home Medicaid benefit program.
This program works a lot like private medical insurance except it is run by the government. While on Medicaid, your parent has a monthly co-payment based on their income and every medical expense that costs more than that co-payment is paid directly by the government. You don't even see a bill.
To qualify for Medicaid, your parent will need to meet certain income and asset requirements. Once they are approved, they will be able to receive the nursing home care they need at a price they can afford. So, if you are concerned about how your parent will pay for nursing home care, schedule your free strategy call today.
The Nursing Home Spouse's Social Security
When one spouse is in a nursing home and there is a healthy spouse at home, the process of allocating their social security benefits begins with a Medicaid co-payment. This co-payment is equal to the nursing home spouse's monthly income minus specific deductions; however, the important part is it is capped at their monthly income. In addition to the cap, in many cases we can reduce the co-payment even more to divert additional income to the healthy spouse at home. This process can be complicated, so it is important to seek professional help to ensure that you are getting the best possible outcome for your situation.
The Healthy Spouse's Social Security
With one spouse needing a nursing home, it is natural to be concerned about what will happen to the social security income of the healthy spouse.
Will they lose all of it?
Will they lose some of it?
Will they be able to keep all of it?
Here is what you need to know. If the nursing home spouse is approved for Medicaid benefits, then the healthy spouse's social security income will not be used as part of their Medicaid co-pay. The healthy spouse will continue to receive their full amount of social security income every month. This can be a relief for many families, as it ensures that the healthy spouse will still have an income to live on. But, if you do not get Medicaid then someone is going to have the pay the full nursing home bill and it is pretty likely it will eat up all their income plus significant assets.
How Much Will You Pay?
Every dollar counts. This is especially true for a parent on Social Security. Regardless of if the nursing home resident is single or married the process begins by subtracting your medical insurance premiums, other medical costs, and a monthly personal allowance of $60. If you’re not married, most of the time the result of that formula is going to be how much of your Social Security you will pay for nursing home care.
A married nursing home resident that is married may qualify for a very important additional deduction. That deduction is called the spousal diversion or minimum monthly needs allowance. This deduction is only available to married couples and is designed to guarantee a minimum monthly income to the healthy spouse at home.
In 2023 the healthy spouse at home is eligible to keep all their combined income up to a maximum of $3,715.50 per month. If the healthy spouse’s income is less than $3,715.50 per month, then he or she will be eligible to divert the nursing home spouse’s income to them rather than a Medicaid co-payment.
For example, if Linda and Michael have respective incomes of $1,000 and $2,000 per month their total combined income is below $3,715.50. As a result, Linda could divert all of Michael’s income to her every month. At the end of the day this special deduction would reduce Michael’s Medicaid co-payment to $0, meaning he could get nursing home care and full medical coverage without having to pay any of his Social Security for it.
If Social Security Isn't Enough, Then Who Pays?
It’s no secret that nursing homes cost a lot more than most people’s Social Security checks. A lot more in most cases. So, who pays the rest of the nursing home bill that the nursing home resident’s Social Security does not pay? Medicare usually pays up to the first 20 days. After those 20 days supplemental Medicare coverage may pay up to 100 days; however, not everyone has the right type of supplemental policy for this coverage.
So, at some point between days 20 and 100 Medicare coverage will run out and you then need to decide if you are going to pay the nursing home bill or if you want to qualify for Medicaid. If you successfully qualify for nursing home Medicaid in Texas, they pay the rest of the nursing home bill that the nursing home resident’s income cannot pay. If you fail to qualify for Medicaid, then all your income and all your assets are at risk to be used for nursing home bills.
Yes, Affordable Care is Within Your Reach
You can have quality nursing home care even if you are on a fixed income. You will need to be knowledgeable about the Medicaid eligibility process and have a plan in place. With the right help, you can get your loved one the care they need without breaking the bank. If you or your family needs affordable nursing home care, schedule a free strategy call today. We have over 20 years of experience and can help you navigate the Medicaid system and get your loved one the care they deserve at a price you can afford.