Nursing home expenses will vary quite a bit from one facility to another, not only around the nation but also in the same city. Although the cost of a private nursing home room in the United States only increased a little over one percent from 2015 to 2016, the median cost is still over $92,000 a year. What is worse is the fact that most of us seriously underestimate these costs when we are creating our estate plans.
How California average monthly nurse home rates compare to the nation
The national monthly rate for a semi-private room is estimated to be $6,692. For a private room, the monthly rate is $7,604. The costs in California are slightly higher than the national average. Nursing home expenses for a semi-private nursing home room in California average $7,450, with the range being anywhere from $2,829 to $27,770 each month. Nursing home expenses for private rooms are higher, with an average rate of $8,669, and a range from $4,380 to $27,770.
Why do nursing home expenses differ from one state to another?
Nursing home expenses in each state vary depending on the geographical region and the length of stay. This difference is primarily based on the real estate value in the area. In other words, states and cities that have a higher cost of living will have correspondingly higher nursing home expenses. However, there are other factors that affect nursing home expenses overall.
Nursing home expenses are affected by labor issues
California, like several other states, has a serious shortage of nurses. For that reason, if you want a nursing home with skilled nursing services, you will likely pay a premium price to receive that type of care. Similarly, supply and demand in the healthcare field will have an effect on nursing home expenses as well.
Nursing home expenses are based on length of stay
Nursing home expenses are also affected by the length of time a resident intends to stay in the facility, in other words, whether the admission is short-term or long-term. Short-term care is typically covered by Medicare if you are eligible for those benefits. However, Medicare does not cover long-term care in a nursing home. Medi-Cal is an option, but you must also qualify for those benefits in order to receive coverage.
Obviously, nursing home expenses vary by facility
It goes without saying that every nursing home facility does not charge the same amount. Nursing home expenses can depend on how new the facility is or whether it has a high number of vacancies. You can always try to negotiate a reduction in fees based on certain conditions that you may not require.
When Does Medi-Cal Pay for Nursing Home Care?
Long-term care facilities, like a nursing home or assisted living facility, are often very expensive. Unfortunately, private health insurance policies usually do not cover these services. Medicare coverage for long-term care is limited and most people do not have private long-term care insurance policies. For California residents who require long-term care services, Medi-Cal is the source of funding most often used. In fact, Medi-Cal covers the nursing home expenses of nearly 65% of California residents in nursing homes.
What is Medi-Cal?
Medi-Cal, California’s state Medi-Cal program, is funded by both federal and state funds. There are several different methods for obtaining eligibility for Medi-Cal. There are also eligibility rules specifically for long-term care services like nursing homes, assisted living facilities, and home healthcare services. The California Department of Health Care Services (DHCS) administers long-term care programs in California.
Payment for “medically necessary” nursing home services
Skilled nursing facilities are residential facilities that offer round-the-clock skilled nursing care in addition to other supportive services. Most people cannot afford to pay their own nursing home expenses. Medi-Cal pays for nursing home services only when those services are deemed “medically necessary.”
California defines that term as “when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.” In order for Medi-Cal to pay for a nursing home stay, it is necessary for the patient’s treating physician to prescribe a nursing home, based on the need for continual, round-the-clock availability of skilled nursing care or what’s called “intermediate care.”
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