Paying for Care
Residents may use one or more of these means to pay for long-term care.
Note: Click on an item below to reveal the information.
Some people enter a nursing home as private pay residents, using a combination of resources to pay their expenses and eventually "spend down" their resources and meet the requirements for Medicaid to pay for care.
Some nursing homes require payment upon admission. If a resident pays for nursing home care with personal funds and depletes their resources, they may then qualify for Medicaid. In such cases, the state of Texas reimburses the nursing home for up to 3 months before Medicaid approval. The nursing home then refunds personal payments according to specific time limits.
Assisted Living Facilities
People who live in assisted living facilities typically pay for their care with personal funds. The facility's cost is based on the resident's needs. Charges are explained and agreed upon in the resident contract prior to the resident moving into the facility.
Long-term care insurance is sold by private insurance companies to cover costs of care in a nursing home, some assisted living facilities, your own home or a day activity and health services facility (also called adult daycare).
Medicaid provides health-care services for low-income people. In Texas, Medicaid may pay all or part of nursing home and assisted living costs for eligible clients; however, residents contribute toward their care, based on income and other considerations.
Medicare is a federal health insurance program for people 65 years of age or older and certain people with disabilities. If you need skilled nursing home care, sometimes called rehabilitative care, Medicare may pay for limited time periods. It does not pay for ongoing long-term care, such as extended nursing home stays.
Medigap is a supplemental Medicare insurance policy designed to fill in the "gaps" in Medicare coverage. This means that Medigap can help you cover Medicare co-payments and deductibles, which could include a portion of your daily payments during a short-term stay at a skilled nursing facility.
Like Medicare, Medigap policies generally do not cover long-term stays in a nursing home, nor do they cover things like vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
If you are part of an employee group plan, a member of a Medicare HMO or on Medicaid, you probably do not need a supplemental Medicare insurance policy, so consider these options before you buy a Medigap policy.
Updated: March 2, 2016
The Office of the State Long-term Care Ombudsman is independent of the Texas Health and Human Services system. This ensures the state ombudsman and all program representatives advocate for resident interests. Ombudsmen work to solve individual problems and to change policy and law to protect residents.