Nursing Home Coverage By Medicare

Medicare is a federal health insurance program that provides comprehensive coverage to people 65 years old or older. In addition, Medicare Advantage plans and Medicare Part D prescription drug coverage are also available to eligible beneficiaries. The following describes what Medicare does and does not cover:

Nursing Home Coverage By Medicare

1 Medicare 2019 eligibility

Medicare is available to people age 65 and older. It is also available to people under age 65 with certain disabilities, and to those with End-Stage Renal Disease (ESRD). In addition, Medicare Part A coverage is now being extended to some individuals who have been diagnosed with amyotrophic lateral sclerosis (ALS).

For more information about Medicare eligibility requirements, visit https://www.medicare.gov/about-us/history/timeline_1960s_1970s/eligibility-requirements-the-early-years/.

2 Inpatient hospital stays longer than 60 days.

If you are a beneficiary enrolled in Medicare Part A and Part B, Medicare does not cover inpatient hospital stays for more than 60 days. However, if you have limited coverage due to the End Stage Renal Disease (ESRD) treatment limit or the Chronic Kidney Disease (CKD) treatment limit on your Part D drug plan, you may be able to get additional coverage under Original Medicare by purchasing an additional supplement policy called Medigap F.

3 Skilled nursing care

Skilled nursing care is covered by Medicare only if it is part of a hospital stay. Skilled nursing facility (SNF) stays may be covered for up to 100 days.

Medicare covers skilled nursing care, but not custodial or general in-home assistance services provided under Part A of Medicare. This means that you might have to pay for these services out-of-pocket unless your health plan provides them at no cost as an extra benefit.

4 Medical supplies

• Medical supplies such as catheters, canes and walkers are covered.
• Oxygen and portable oxygen equipment are covered.
• Prosthetic devices (such as artificial limbs) are covered.

If you need a wheelchair to get around, that’s also covered by Medicare. But if you’re confined to bed or a chair all day, your Medicare benefits won’t pay for special equipment that allows you to watch television or listen to music while indoors—even if it helps with your mood or prevents depression due to isolation or boredom. You’ll have better luck with Medicaid at this point!

5 Hospice care for terminally ill patients.

If you’re receiving hospice care for a terminal illness, Medicare pays for it. However, this coverage only lasts for six months. After that period of time, your Medicare benefits end and you may be responsible for paying for any additional care out-of-pocket if your condition worsens or continues to deteriorate.

6 Medicare is comprehensive but does not cover everything.

Medicare is a government-sponsored health insurance program for people 65 years or older. It covers hospital stays, skilled nursing care, hospice care and some home health services. It also helps pay for many prescription drugs.

In addition to Part A’s benefits, Medicare Part B (which you must pay for) offers access to physicians and other providers through participating networks. With this coverage, you can visit your doctor or get services from hospitals and clinics associated with the plan without having to first get a referral from your primary care physician as long as they participate in the Medicare network. You’ll be responsible for paying any copayments (a set amount that you owe when receiving certain medical services), deductibles (the amount of money you are responsible for paying before your insurance coverage kicks in) and coinsurance fees (the percentage of total charges that your insurer pays after meeting its obligation toward those charges).

Closing

Medicare is a government program that provides health insurance to Americans who are 65 or older, as well as younger people with disabilities. Medicare offers comprehensive coverage for many services and treatments but does not cover everything. If you need nursing home care or other services covered by Medicare, you may be able to get them through Medicaid or private insurance instead.