Medicare is an insurance program that covers people aged 65 or over (and with specific medical ailments) throughout the United States.

The programs cover hospital stays, outpatient care, and preventive health care. In addition, Medicare can provide short-term stays at an assisted living facility when someone requires skilled assistance.

If you want to know whether Medicare provides coverage for nursing home care, continue reading.

A nursing facility is where a person receives additional care from nurses.

Some of these facilities might be apartments or homes that cater to those who require extra support for their daily tasks or don’t want to be in a home. Many resemble hotels or hospitals equipped with rooms with baths and beds and common areas for classes, dining, or unwinding.

Most nursing homes provide around-the-clock care. Services may vary but can include help in getting a bathroom trip, help with medication, and meal service.

To know what Medicare covers for the nursing home, it’s often essential to understand what they do not provide. Medicare does not cover care at a nursing home if someone requires custodial care only. 

Custodial care consists of the following services:

In general, if a person requires treatment that doesn’t need the provision, Medicare doesn’t cover the treatment.

Medicare covers skilled nursing care at the nursing home; however, you must be able to meet a variety of criteria. It includes:

Medicare typically only provides short-term skilled nursing services in a nursing facility. To know more about a breakdown of the services Medicare covers in connection with nursing homes, continue reading.

Some of the services Medicare Part A might provide in a nursing home setting include:

Medicare could also cover what’s known as “swing bed services.” When a person receives skilled nursing facility services in an acute care hospital, it happens.

Medicare Part B is the part of Medicare that covers outpatient services such as health screenings and doctor visits. However, this part of Medicare does not typically cover nursing homestays.

Medicare Advantage Plans (also known as Medicare Part C) do not typically cover nursing home services considered custodial care. However, some exceptions are made for those whose plan agrees with a particular nursing facility or an organization that manages nursing homes.

Always call your plan’s provider before going to the nursing home you’re considering so you know what isn’t covered by your Medicare Advantage policy.

Private insurance companies offer Medigap Supplement plans . In addition, they assist in covering additional costs like deductibles.

Specific Medigap plans could help cover coinsurance for skilled nursing facilities. For example, it includes plans C, D, F, M, and N. Plan K covers 50 percent of coinsurance, while Plan L is responsible for 75 percent.

The problem is that Medigap supplements don’t provide long-term nursing homes.

Medicare Part D is a prescription drug coverage that pays for all or just a part of a person’s prescriptions.

If a person is in a nursing facility, they’ll usually receive prescriptions from a pharmacy that supplies medications for people who reside in long-term such as nursing homes.

If you’re a skilled institution receiving skilled nursing services, Medicare Part A will typically cover prescriptions at this time.

The majority of Medicare plans don’t provide the care of nursing homes. However, there are exceptions. For instance, you can purchase a Medicare Advantage plan with an agreement specifically with a nursing residence. However, this is often an option, not the norm, and chances are different in terms of geography.

If you or someone you love could require a move to long-term nursing home treatment, alternatives outside of Medicare could help to offset some of the costs. These includes:

Specific individuals might need Medicaid services once they have exhausted their financial resources.

Medicare Part A may offer skilled nursing services at an in-home nursing facility, provided one meets the criteria.

However, you must ensure that someone close to you would like to stay in a nursing center for a prolonged period for caregiving or other services. You’ll likely be required to pay out of your pocket or utilize a long-term care policy or Medicaid services for nursing home care.

If you have any additional questions on nursing home care regarding Medicare, you can contact our licensed medicare insurance agents specializing in Medicare. Also, visit our website for more info!