Overview of Medicare Coverage for Nursing Homes
For those needing long-term care, nursing homes can provide an important source of support. However, many people are uncertain about whether or not Medicare covers nursing home care. To understand if Medicare will cover your nursing home stay, it’s important to know the basics of Medicare coverage and what types of services are included.
What is Medicare?
Medicare is a federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). The program provides coverage for a wide range of medical services and treatments for those 65 and older, as well as certain younger individuals with disabilities. Coverage includes hospital stays, doctor visits, lab tests, and some preventive care.
How Does Medicare Cover Nursing Home Care?
Medicare does not typically cover the cost of long-term care in a nursing home. Medicare Part A (Hospital Insurance) may cover a limited amount of short-term care in a skilled nursing facility if certain conditions are met. These include:
- A three-day qualifying hospital stay in the last 30 days
- Admission to a skilled nursing facility within 30 days of the qualifying hospital stay
- Receiving medically necessary skilled care from the nursing facility
If these conditions are met, Medicare Part A will cover up to 100 days of care in a skilled nursing facility. After that, there may be additional coverage available through Medicare Advantage plans or through private insurance.
What Types of Services Are Covered by Medicare at Nursing Homes?
Medicare Part A covers a range of services at a skilled nursing facility, including:
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech language pathology
- Medical social services
Services must be ordered by a doctor and provided by or under the supervision of a licensed professional. Medicare Part A also covers durable medical equipment, such as wheelchairs and walkers, as well as medications and supplies related to the treatment plan.
What Services Are Not Covered by Medicare?
Medicare does not cover custodial care, which is assistance with activities of daily living such as bathing, dressing, eating, and using the bathroom. It also does not cover meals, room and board, or personal care items such as toiletries and diapers. These services may be covered by other programs, such as Medicaid or long-term care insurance.
How to Find a Nursing Home That Accepts Medicare
When looking for a nursing home, it’s important to make sure it accepts Medicare. There are several resources available to help you find a nursing home that meets your needs and accepts Medicare.
Researching Facilities in Your Area
Start by researching nursing homes in your area. Check online directories, such as Medicare’s Nursing Home Compare website, for detailed information about each facility, including ratings, reviews, and contact information. Contact the facilities directly to inquire about their policies on accepting Medicare.
Working With Local Agencies
Local agencies, such as Area Agencies on Aging, can also provide information about nursing homes in your area and help you determine which ones accept Medicare. Additionally, they may be able to provide assistance with the application process and help you navigate the system.
Using Online Resources
Online resources, such as the Medicare Rights Center, can provide information about nursing home options and how to apply for Medicare. Additionally, they can answer questions about eligibility, coverage, and costs.
Costs Associated With Nursing Home Care and Medicare
The cost of nursing home care varies depending on the type of care needed and the location of the facility. Medicare generally covers up to 100 days of care in a skilled nursing facility after a three-day hospital stay. During this time, Medicare pays for all medically necessary services, including doctor visits, medications, and supplies. After the 100 days, out-of-pocket costs may apply.
What If You Need More Than Medicare Covers?
If you need more than 100 days of care, you may need to purchase supplemental insurance to cover the additional costs. Long-term care insurance is one option, but it can be expensive. Other options include Medicaid, veterans benefits, and private insurance.
Pros and Cons of Choosing a Nursing Home Covered by Medicare
Choosing a nursing home covered by Medicare can have its advantages and disadvantages. Here are some things to consider before making your decision.
Advantages of Choosing a Facility That Accepts Medicare
- No out-of-pocket costs for medically necessary services
- Access to quality care from skilled professionals
- Peace of mind knowing that your care is covered
Disadvantages of Choosing a Facility That Accepts Medicare
- Long wait times for admission
- Limited availability of beds in certain areas
- Out-of-pocket costs for non-covered services
Tips for Maximizing Medicare Coverage While in a Nursing Home
Here are some tips to help you maximize your Medicare coverage while in a nursing home:
Keeping Track of Expenses
It’s important to keep track of your expenses while in a nursing home. This includes any out-of-pocket costs for medications, supplies, or services not covered by Medicare. Keeping a record of your expenses can help you maximize your coverage and ensure that you don’t overpay.
Knowing What Is Covered and What Is Not
Make sure you understand what services are covered by Medicare and what services are not. Knowing what is covered can help you avoid paying out-of-pocket for services that should be covered by Medicare.
Maximizing Benefits Through Supplemental Insurance
If you need more than 100 days of care in a skilled nursing facility, consider purchasing supplemental insurance to cover the additional costs. Long-term care insurance and other options may help cover the costs of care beyond what Medicare covers.
Common Questions About Medicare and Nursing Home Coverage
Understanding Medicare coverage for nursing home care can be confusing. Here are answers to some common questions about Medicare and nursing home coverage.
Does Medicare Cover All Types of Nursing Home Care?
No. Medicare Part A covers a limited amount of care in a skilled nursing facility. It does not cover custodial care, meals, room and board, or personal care items.
Does Medicare Cover Long-Term Care?
No. Medicare does not typically cover long-term care, such as custodial care. However, some Medicare Advantage plans may offer coverage for long-term care.
Are There Any Limitations on the Amount of Time Medicare Covers Nursing Home Care?
Yes. Medicare Part A typically covers up to 100 days of care in a skilled nursing facility after a three-day hospital stay. After that, coverage may be available through other sources, such as Medicare Advantage plans or private insurance.
Can I Switch Nursing Homes If I Don’t Like the One I Am Currently In?
Yes. You can switch nursing homes at any time, as long as the new facility accepts Medicare. You will need to apply for admission to the new facility, and your doctor will need to approve the transfer.
Conclusion
Medicare can provide coverage for a limited amount of care in a skilled nursing facility, but it does not typically cover long-term care. Before choosing a nursing home, it’s important to understand what is covered by Medicare and what is not, as well as any out-of-pocket costs. Additionally, it’s important to research nursing homes in your area to make sure they accept Medicare. With the right information and resources, you can make sure you get the care you need while maximizing your coverage.
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