Medicare is a federal health insurance program available to people who are 65 years of age or older, younger people with disabilities, and people with end-stage renal disease. Medicare Part A covers hospital services, while Part B pays for physician services and outpatient care. Medicare also covers what it calls “skilled” nursing home care through its “cognitive impairment” benefit.
Medicare Coverage Of Nursing Home
1 medicare covers what it calls “skilled” services.
When you’re in a nursing home, Medicare can pay for skilled nursing care that is medically necessary to treat or prevent an illness or injury.
Medicare covers what it calls “skilled” services. These are provided by licensed nurses and other trained health care professionals such as therapists and physical therapists. These individuals must have completed the appropriate education and training for their job responsibilities and meet state licensing requirements in order to provide these services.
2 Only medicare part a covers nursing home stays under specific conditions.
Medicare part A covers skilled nursing care if you have a condition that is expected to improve. It does not cover long-term stays in a nursing home.
The following are some examples of conditions that Medicare part A may cover:
- short-term hospitalization, typically for up to 100 days (20 full months) in one year
- dialysis treatment for end-stage renal disease (ESRD) patients who have ESRD for at least three months and require dialysis three times per week or more frequently
3 medicare part b covers some costs when you’re receiving care in a nursing home.
Medicare Part B covers some costs when you’re receiving skilled nursing care in a nursing home. The following is a breakdown of Medicare coverage for this type of care:
- Durable medical equipment (non-hospital)
- Outpatient therapy
- Skilled nursing facility services
- Home health servicesFor more information on specific items, you can visit the Centers for Medicare and Medicaid Services website at [www.medicaid.gov](http://www.medicaid.gov/).
4 private insurance may pay for a nursing home stay.
If you pay for your nursing home care out of pocket, private insurance may still cover it. This is true if you have a high deductible, health savings account (HSA), or health reimbursement account (HRA).
If you are covered by an HSA or HRA, the money that goes into it can be used to pay for nursing home care. You do not have to use this money on other things first; in fact, using it for nursing home care will save money because Medicare does not cover these expenses. However, there are situations where private insurance may pay more than Medicare does and vice versa.
5 long-term care insurance may help with nursing home costs.
Long-term care insurance is a type of coverage that can help you pay for the costs associated with nursing home care. This type of insurance is designed to pay for the cost of living in a nursing home and other types of long-term care services, such as assisted living or adult daycare.
If you want to protect yourself and your loved ones from the high out-of-pocket expenses associated with nursing home care, consider purchasing long-term care insurance. Long-term care policies are available to anyone who meets their eligibility requirements, which usually include being over age 65 at policy purchase or reaching age 80 during the policy term (called guaranteed issue).
6 you can talk to an insurance agent to learn about medicare coverage for nursing homes.
You need to talk with an insurance agent if you want to learn more about Medicare coverage for nursing homes. An insurance agent can help you understand what Medicare covers, as well as what private insurance or long-term care coverage will cover. You will be better able to make decisions about your own health care when armed with this information.
7 medicare pays for certain types of care in a nursing home, but not all of it.
Medicare Part A (hospital insurance) pays for some types of care in a nursing home, but not all.
Medicare Part A covers skilled nursing care. Skilled nursing care means services that are needed to prevent or cure an illness or injury, or relieve pain and discomfort. Medicare will pay for skilled nursing care only if you meet the following conditions:
- You must be admitted to a Medicare-approved hospital as an inpatient for at least 3 days. You can be hospitalized as long as necessary to recover from your illness or injury and stabilize your condition before being discharged to a skilled nursing facility (SNF). Your stay does not have to last 3 consecutive days; it just needs some time between admissions and discharges. For example, if you have surgery on Tuesday and are sent home Thursday morning, then the SNFs may accept you back into their facilities any time after Thursday morning until Sunday night if there is room available.*
Medicare covers certain types of care in a nursing home under specific circumstances. If you are considering moving into one, it’s important to understand the rules and regulations. Talk with an insurance agent or other financial advisor who can help you think through how best to afford this type of treatment.