Many older Americans wonder how they’ll pay for long-term care in the future if they aren’t able to live at home. There are limited circumstances where a short-term stay in a nursing home is covered by Medicare. However, a lot of nursing home care is not covered by Medicare.
This article will help you understand when Medicare covers nursing homes, when it doesn’t, and what options are available to you.
Medicare Part A covers limited nursing home care for medical needs. If custodial care is your only health need, then Medicare coverage does not apply.
For example, Medicare Part A may provide coverage if you need to stay in a certified skilled nursing facility for a short period of time to recover from a fall or an illness after a qualifying hospital stay. There are a number of requirements before this coverage is available, such as having Part A coverage days left, a doctor saying you need skilled nursing care, and more.
If you have Original Medicare coverage, you’ll pay a $0 copayment for days 0-20 in each benefit period, a $194.50 per day copayment for days 21-100, and you’ll be responsible for all costs from day 100 onward.
Medicare does not pay for long-term care at a nursing home. If you have medically-required care at a skilled nursing facility and Medicare Part A provides coverage, you can receive coverage for up to 100 days.
Beyond 100 days, you will have to pay all of the costs associated with treatment at the skilled nursing facility.
As we mentioned, long-term nursing home care is not covered by Medicare. However, Medicare Part A and B can help with coverage for some home health services that can assist an Alzheimer’s patient that is still living at home.
If an Alzheimer’s patient needs intermittent skilled nursing care for less than 21 days, Medicare can help provide coverage for this need.
However, Medicare does not provide coverage for:
Medicare Part A will help cover the cost of being in a skilled nursing facility for rehabilitation for a short time after a qualifying hospitalization. There are conditions that must be met, such as having Medicare Part A days available and receiving medically-necessary care.
For the first 20 days, you don’t pay a copayment. From day 20-100, you’ll pay a daily copayment for nursing home rehabilitation. Day 101 and beyond are not covered by Medicare, so you’ll need to pay those costs yourself.
Services covered include a semi-private room, meals, physical or occupational therapy, medications, and more. The goal is to provide short-term care so that you can recover fully and live successfully at home again.
Medicare Part A does include coverage for hospice. In order to receive coverage, a hospice doctor and the patient’s doctor must certify that the patient is terminally ill, which means there is a life expectancy of six months or less.
Hospice care is designed to make the patient comfortable, not cure an illness. Benefits include pain relief and symptom management services, medical and nursing services, medication and durable medical equipment as needed, homemaker and aide services, and spiritual and grief counseling for loved ones.
You pay nothing for approved hospice care, but there may be a small copay for outpatient drugs for pain management. You may also pay 5% of the Medicare-Approved amount for respite care.
Those approved for hospice care generally have less than six months to live. If the care lasts longer than six months, the doctors must re-certify that you are still terminally ill.
There isn’t a hard limit for hospice care, but the expectation is that the care will not exceed a year. If the doctors do not recertify that the patient has six months or less to live, then hospice benefits will end.
Medicare only covers short-term skilled nursing care, not long-term care in a nursing home. However, there are other payment options for nursing homes, such as Medicaid, long-term care insurance, or personal funds.
If you’d like to learn more about Medicare and nursing homes or need help comparing Medicare plans to choose the best option, talking to a licensed agent may help. Contact us today for more information!