Frequently Asked Questions about Skilled Nursing Care

How do I Pay for Inpatient Skilled Nursing Care?

If an individual is hospitalized for a minimum of three nights and it becomes clear he or she will need inpatient skilled nursing care, the Federal Medicare Program and most commercial insurers provide initial coverage upon hospital discharge. Every insurer has different rules for coverage.

To clarify any restrictions on coverage, it is best to speak with your insurance company or the skilled nursing center to which you seek admission. After traditional coverage ends, most people either make private pay arrangements or apply for the joint state and federal health insurance program, MassHealth.

What is Long-term-care Insurance?

Another option for covering inpatient skilled nursing care after traditional coverage ends is the purchase of a long-term care insurance policy. As with all insurance programs, long-term care insurance is a way to insure that the funds for nursing home care are in place when needed. Generally, there is a waiting period.

However, many policies offer elimination of the waiting period in exchange for a higher premium. If the purchase of a policy is an option, individuals and families should consider several aspects of the policy, including a full explanation of eligibility and the coverage to be provided, as well as whether hospitalization is a prerequisite for the receipt of nursing home benefits.

For more information about long-term care insurance contact the web sites of the Massachusetts Senior Care Association (formerly called The Massachusetts Extended Care Federation) or AARP.

What is a Health Care Proxy and When Should I complete one?

A Health Care Proxy is a legally binding document in Massachusetts that enables a patient to ensure his or her wishes are followed regarding his or her future health care. In the event an individual is unable to make decisions about his or her own medical care, a health care agent whom that person has previously designated, will execute the person’s wishes.

Health Care Proxies must be completed when an individual is mentally competent to do so. However, since accidents and illness are often unexpected, it is recommended that Health Care Proxies are written in advance of a crisis while there is time to calmly and thoroughly discuss a person’s wishes regarding healthcare and treatment.

Further information and forms please visit the Massachusetts Medical Society, Health Care Proxy.