Medicare and Nursing Homes: Coverage and Other Things to Know

Medicare and Nursing Homes: Coverage and Other Things to Know

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.

What is a Nursing Home, Exactly?

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.

Benefits of Nursing Home Care

  • The nursing home can allow the person to live independently without being involved in household maintenance tasks, such as mowing the grass or maintaining a home.
  • Many nursing homes offer social activities that allow residents to meet with other people and build friendships and other activities.
  • Receiving necessary nursing care and having staff trained to supervise a patient could provide security for the person and their loved ones.

Does Medicare Provide Nursing Home Care?

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:

  • bathing
  • dressing
  • eating
  • getting to the bathroom

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:

  • The user must have enrolled as a Medicare Part A beneficiary. 
  • The first step is to have completed a medically approved stay.
  • Your physician must determine if you need daily, expert nursing medical attention.
  • The care you need can only be provided in a skilled nursing facility.
  • The location you receive your services must meet Medicare’s requirements.
  • You need skilled help in the situation of a medical concern connected to a hospital visit or a condition that first appeared while you were in a skilled nursing facility looking for assistance.

What Parts of Medicare Provide Nursing Home Care?

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.

Medicare Part A

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

  • Dietary counseling and nutrition counseling
  • Medical equipment and medical supplies
  • Medicines & Meals
  • Occupational therapy
  • Physical therapy
  • Semi-private room
  • Skilled nursing care, for example, changing the dressing on wounds
  • Social work-related services that relate to medical treatment that is required
  • Speech-language pathology

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

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 Part C

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.

Medigap Supplements

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.

Part D

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.

Suitable Medicare Plans if You Require Nursing Home Care

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:

  • Long-term care insurance: It can cover all or a part of nursing home expenses. Many people purchase these insurance policies at a younger age, like their 50s, as costs typically increase as one gets older.
  • Medicaid: Medicaid, the insurance program that assists people in households with lower incomes, includes national and state programs to help pay for the care of nursing homes.
  • Veterans Administration: Veterans who have served in the military might receive financial aid for long-term care services from the United States Department of Veterans Affairs.

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

Conclusion

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 agents specializing in Medicare. Also, visit our website for more info!

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