How to Get Financial Assistance for Nursing Home Care in PA

Paying for nursing home care can be one of the most significant financial challenges families face, particularly as the costs of nursing home care continue to rise.

In Pennsylvania, nursing homes provide different levels of care, from personal care in assisted living communities to more intensive skilled nursing care in a skilled nursing facility.

Whether your loved one needs a semi-private room or room and board in a private setting, financial assistance is available.

Understanding the payment options and eligibility requirements for assistance can ease the financial burden and help ensure that nursing home residents receive the care they need.

Understanding the Costs of Nursing Home Care in Pennsylvania

The cost of care in a nursing home can vary significantly depending on the level of care required, the location, and the type of room chosen. On average, in Pennsylvania, the cost for a semi-private room in a nursing home can range from $7,000 to $9,000 per month. For a private room, the cost can exceed $10,000 per month.

• Skilled Nursing Care: If your loved one needs skilled nursing care, which includes 24/7 medical supervision, physical therapy, or post-surgery recovery, expect the costs to be higher. Skilled nursing facilities offer more intensive care, and the financial commitment can be substantial.
• Assisted Living vs Nursing Home Care: Assisted living and nursing home care are often confused. However, assisted living typically involves less intensive medical care and is usually less expensive. Personal care in an assisted living community is ideal for individuals who can manage many daily activities independently but require help with tasks like bathing, dressing, or meal preparation. Nursing homes, on the other hand, cater to those who need skilled nursing care or more intense assistance.

Given the significant financial burden of long-term care, exploring payment options and understanding how to access assistance programs are crucial steps to managing nursing home expenses.

Understanding the Costs of Nursing Home Care in Pennsylvania

The cost of care in a nursing home can vary significantly depending on the level of care required, the location, and the type of room chosen. On average, in Pennsylvania, the cost for a semi-private room in a nursing home can range from $7,000 to $9,000 per month. For a private room, the cost can exceed $10,000 per month.

• Skilled Nursing Care: If your loved one needs skilled nursing care, which includes 24/7 medical supervision, physical therapy, or post-surgery recovery, expect the costs to be higher. Skilled nursing facilities offer more intensive care, and the financial commitment can be substantial.
• Assisted Living vs Nursing Home Care: Assisted living and nursing home care are often confused. However, assisted living typically involves less intensive medical care and is usually less expensive. Personal care in an assisted living community is ideal for individuals who can manage many daily activities independently but require help with tasks like bathing, dressing, or meal preparation. Nursing homes, on the other hand, cater to those who need skilled nursing care or more intense assistance.

Given the significant financial burden of long-term care, exploring payment options and understanding how to access assistance programs are crucial steps to managing nursing home expenses.

Financial Assistance for Nursing Home Care

There are several payment options available to help offset the costs of nursing home care in Pennsylvania. These include Medicaid, Medicare Part A, long-term care insurance, private pay options, and state-specific programs like Medicaid waivers. Here’s a closer look at each option.

Medicaid: The Most Common Assistance Option

Medicaid is the largest source of funding for nursing home care in Pennsylvania. Medicaid helps cover the cost of room and board, skilled nursing care, and other essential services for those who meet eligibility requirements. However, Medicaid’s coverage of nursing home residents is not automatic. Individuals must meet both financial and medical eligibility criteria.

Eligibility Requirements for Medicaid in Pennsylvania

To qualify for Medicaid in Pennsylvania, individuals must meet certain income and asset limits, which are determined by both federal and state guidelines. Medicaid is a joint federal-state program, so the specifics can vary from state to state, and Pennsylvania has its own set of rules.

• Income Limits: For a single individual, the income limit is generally set around $2,400 per month, though this figure can change. Spouses may have different income limits, especially if one spouse is still living at home.
• Asset Limits: Medicaid has strict asset limits. In Pennsylvania, a single applicant’s countable assets must be below $2,000. However, some assets are exempt from these limits, such as the applicant’s home (if they plan to return to it), a car, and personal belongings.
• Spending Down: If your loved one’s income or assets exceed Medicaid’s limits, you may need to “spend down” your savings to qualify for Medicaid. This means using assets to pay for care services until you meet the financial requirements. In some cases, a Medicaid waiver may allow for more flexibility in eligibility.
• Medicaid Waivers: These programs are designed for individuals who need long-term care but are not in a skilled nursing facility. Medicaid waivers can be used to cover the costs of home and community-based services or certain types of care in assisted living communities. However, Medicaid waivers often have waiting lists, so it’s important to apply early.

What Medicaid Pays For

Medicaid helps cover most nursing home costs of care, including:

• Skilled nursing care
• Room and board
• Personal care
• Therapies (physical, occupational, speech)
• Medical supplies

Medicaid will also pay for semi-private room accommodations in a nursing home. If a private room is desired, it may be necessary to pay the difference between what Medicaid covers and the cost of a private room.

Medicare Part A: Short-Term Coverage

Medicare Part A can help with nursing home costs, but it’s limited to short-term care. If your loved one is recovering from a hospital stay, Medicare can cover up to 100 days of care in a skilled nursing facility (SNF) under certain conditions.

What Medicare Covers

• First 20 Days: Medicare covers 100% of the costs for skilled nursing care in an SNF for the first 20 days.
• Days 21-100: For days 21 through 100, Medicare covers partial costs, and the individual is required to pay a daily copayment, which is expected to be around $200 per day (as of 2025).
• After 100 Days: Medicare stops covering nursing home costs after 100 days, leaving the individual to either pay privately or transition to Medicaid if eligible.

Medicare Part A is a great option for short-term care, but it does not cover long-term care needs, such as help with ADLs over an extended period.

Long-Term Care Insurance

Long-term care insurance is a private insurance policy that helps cover the costs of nursing home care, assisted living, and other types of long-term care. These policies vary widely in terms of coverage, premiums, and eligibility requirements, but they can be a valuable option for those who can afford the premiums.

• What it Covers: Long-term care insurance typically covers a range of services, including skilled nursing care, room and board, personal care, and assistance with ADLs. Policies can also be used for care in a skilled nursing facility or assisted living communities.
• Eligibility Requirements: To qualify for long-term care insurance, individuals typically need to apply before they are in poor health. The cost of premiums will increase with age and pre-existing conditions, so it’s important to purchase this type of insurance early.
• Paying for Nursing Homes: Long-term care insurance can help reduce the financial burden of paying for nursing home care and avoid reliance on government programs like Medicaid.

Private Pay Options

If your loved one has sufficient savings, investments, or assets, paying for a nursing home out-of-pocket (private pay) is also an option. This option allows individuals to select their preferred skilled nursing facility or assisted living communities without waiting for Medicaid approval.

However, paying privately for care can become expensive, particularly if long-term care is needed. For those with significant assets, it’s important to plan ahead and consider alternatives, such as long-term care insurance or Medicaid.

State-Specific Programs and Other Resources

Pennsylvania has additional programs that help residents pay for nursing home care, including the PACE program (Program of All-Inclusive Care for the Elderly) and State Supplemental Payments for those eligible for Medicaid.

The PACE program offers comprehensive care services to eligible seniors, including medical care, rehabilitation, and nursing home care, all through a single, coordinated system. It is designed for those who are eligible for Medicaid and have complex health needs.

Paying for nursing home care in Pennsylvania can be complex, but there are several payment options to help manage the costs. Whether you’re looking at Medicaid, Medicare, long-term care insurance, or private pay options, understanding the eligibility requirements and coverage options is crucial.

For those who need long-term care, Medicaid is the most common source of financial assistance, covering most nursing home costs once eligibility is met.

However, Medicare and long-term care insurance can provide additional options for shorter stays or specific care needs.

By exploring all your options and planning ahead, you can ensure that your loved one receives the care services they need without undue financial strain.