Will we have to pay out of pocket costs for nursing home care for my grandmother who has Alzheimers?

3 answers | Last updated: May 27, 2015
A fellow caregiver asked...

A nursing home rep told my mom that if she puts my grandmother in a nursing home that, due to her severe Alzheimers, (my grandmother has Medicare and Medicaid of Tx), my mother has to still pay out of pocket costs. She said this is because the insurances do not pay for a nursing home stay in full. Is that true?

Expert Answers

Not necessarily. It's true that Medicare nursing home coverage  is very limited. It pays for only a certain amount of the cost of nursing home care, for only a limited time, and only following a period of hospitalization.

But Medicaid is very different. It can pay the full cost of nursing home care for an unlimited time. However, not all nursing homes accept Medicaid-paying residents. And some nursing homes that accept a limited number of Medicaid-paying residents may not have space available for your grandmother (as a Medicaid-paid resident) when she wants to move in.

But if three things line up for her, Medicaid could pay the full cost of your grandmother's nursing care for as long as she needs it: (1) you find a nursing home that you and your mother think would provide good care for your grandmother; (2) that nursing home accepts Medicaid-paying residents; and (3) the nursing home has a Medicaid-paying bed available.

To find out about Medicaid nursing home coverage in Texas, go to the official Texas Medicaid web page. It can also provide you with a listing of Texas nursing homes that accept Medicaid-paying residents.

Community Answers

Kclady answered...

I have been so frustrated with the entire NH deal and Medicaid in Illinois. First of all Medicare only paid 25 days of care and we were told by the NH we would have 120 days covered. Now we have back pay and medicaid says one thing and the NH says another. It has been a real mess. I can't keep mom home due to I have to work full time and she has dementia and needs 24 hr care, yet medicare and medicaid don't pay--UGH!!! She has supplemental insurance we are paying for too and wonder what good it ids doing as it won't pay any of the NH coverage either. We give the government money for years for medicare and now mom can't even use it to help pay for the NH because she just has dementia and is physically ok. Lovely government--no help they are.

Solveig answered...

i believe the previous response on N.H. would apply to your situation here. Medicaid, though not ideal is a huge help with these situations. As you may know, most people if they live past 70 tend to use a lot more than they put in those programs, which means that our youngsters are stuck with the bill. (Not the government's fault, it is the medical profession and nursing home that want too much of our $$$)