What Seniors Should Know About Nursing Home Coverage By Medicare

Everyone needs help as they grow older. In fact, U.S. News reports that almost 70 percent of people turning 65 will need some type of long-term care. Despite the need for long-term care, it can be unaffordable for many. That’s why it helps to have insurance coverage in case you ever need help from professional nurses. To find nursing home coverage, start an online search to see the plans offered by insurance companies.

Medicare may be able to help pay for nursing home stays, but only under certain circumstances. Learn more about what’s covered with a Medicare plan by searching online.

Does Medicare Cover Nursing Homes?

Medicare can help pay for the cost of nursing, but not long-term stays at nursing homes. Instead, they cover something called skilled nursing facilities. Essentially, what’s covered is the type of care that can only be given by a registered nurse or doctor. Medicare covers this type of service for a limited time on a short-term basis.

So, what professionals qualify as a skilled nurse? Here are some examples:

  • Registered nurses;
  • Licensed practical and vocational nurses;
  • Physical and occupational therapists;
  • Speech-language pathologists, and;
  • Audiologists.

That being said, Medicare does not cover traditional nursing home facilities. These are considered non-skilled personal care and custodial care. Anything related to helping people with performing regular daily living is not covered.

Some examples of nursing care services that are not covered include:

  • Bathing;
  • Dressing;
  • Eating;
  • Getting in or out of bed or chair;
  • Moving around;
  • Using the bathroom, and;
  • Health-related care people cannot do themselves, such as eye drops.

If you do want coverage for nursing homes, it might help to look into Medicare Supplement Insurance (Medigap). This type of plan can help you find coverage sold by private companies for things not covered by Medicare. They can help you pay for remaining health care costs like copayments, coinsurance, and deductibles. Search online to learn more about Medigap.

Coverage From Medicare

Medicare can help pay for skilled nursing facility costs under certain conditions. First, it must be considered a medically necessary treatment by a doctor and approved by Medicare.

Skilled nursing facility coverage falls under Medicare Part A. In order to receive coverage, you must meet the following qualifications:

  • You have Part A and days left in your benefit period to use.
  • You have a qualifying hospital stay.
  • Your doctor has deemed daily skilled care medically necessary.
  • You get these skilled services in a skilled nursing facility that’s certified by Medicare.
  • You need these skilled services for a medical condition that’s either:
  • A hospital-related medical condition treated during your three day inpatient hospital stay.
  • A condition that started when you were getting care in the SNF for a hospital-related medical condition.

If you meet all of these qualifications, here is what you will pay and what Medicare will cover:

  • Days one to 20 will cost $0 for each benefit period.
  • Days 21 to 100 cost $185.50 coinsurance per day of each benefit period.
  • From days 101 onward, you will be responsible for all costs.

Medicare can help pay for short-term skilled nursing home stays. You can learn more about the ins and outs of what’s covered by searching online or speaking with a Medicare customer service agent.

Learn More About Medicare Coverage Online

If you want skilled nursing included in your healthcare plan, then you must be enrolled in Plan A. This can give you monetary assistance for up to 100 days should you ever need services from a skilled professional.

Medicare offers a variety of health plans, many of which include Plan A services. It’s important to read up on what each plan offers to ensure you’re getting coverage for what’s most important to you.

Here’s a brief rundown of each Medicare plan:

  • Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Medicare Part B (Medical Insurance): Covers certain doctor services, outpatient care, medical supplies, and preventive services.
  • Medicare Part C (Medicare Advantage): Provides you with both Part A and Part B coverage.
  • Medicare Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs, shots, or vaccines.
  • Medigap: Supplement insurance sold by private companies that can help pay for remaining costs you Medicare plan doesn’t cover, such as copayments, coinsurance, or deductibles.

Whether you’re looking to enroll or want to make adjustments to your current Medicare health care plan, start an online search. You can learn more about what plan can best suit your needs and ensure you’re getting the proper coverage.

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May 17, 2021