Generally, Medicare does not cover long-term care in nursing homes, assisted living facilities, or people’s homes.
However, except in specific cases, home health care provided by a Medicare-approved organization does include long-term care or custodial care (assistance with daily activities such as bathing, dressing, eating, and going to the bathroom).
How Much Will Medicare Cover?
Medicare Part A, which is the part of Original Medicare that covers hospital stays, pays for short-term stays in skilled nursing facilities (SNFs), primarily in nursing homes, with certain limitations.
You may be sent to a skilled nursing facility by your doctor after being in the hospital. There, you’ll get special nursing care and help with rehabilitation. For example, if you had a stroke or a significant injury, you might be able to continue your recovery there.
Furthermore, Original Medicare may help pay some of the costs of a stay in a skilled nursing home for up to 100 days.
Notably, you must go to a skilled care facility within 30 days of leaving the hospital to get the same kind of hospital care.
SNF Requires an Initial Hospital Stay
Qualifying hospital stay or initial hospital stay means you were formally admitted to the hospital for at least three consecutive days. You must have a qualifying hospital stay to be eligible for SNF. You couldn’t have been on “observation.”
The three-day minimum for Medicare coverage in a skilled nursing facility does not apply to time spent under observation.
When you arrive at the hospital, inquire if you are being admitted or if you are being observed. If the latter is the case, you should contact your doctor to determine if you will be permitted to an inpatient facility.
For the first 20 days, if you qualify for short-term coverage in a skilled nursing home, Medicare pays 100% of the cost – meals, nursing services, lodging, etc. After that, you are responsible for a daily copay from days 21 to 100, which in 2019 was $170.50.
If you stay in a skilled care facility for more than 100 days, you’ll be liable for the entire bill unless you have supplementary coverage, such as a Medigap policy.
What Components of Medicare Apply to Skilled Nursing Facilities?
Medicare may cover some or all of the costs of a nursing home. Here’s a rundown of what Medicare may pay for:
- Part A of Medicare provides in-hospital care, but it may also cover short-term care in a skilled nursing facility.
- Part B of Medicare includes outpatient treatments. However, it usually does not cover the costs of nursing homestays.
- Medicare Part C: This bundled plan, commonly known as Medicare Advantage, is administered by private organizations. Long-term custodial nursing home care is typically not covered. However, because coverage mainly depends on the carrier, there may be exceptions.
- Part D of Medicare covers the cost of some or all prescription medications for patients who reside in a custodial nursing home for an extended time.
- Long-term nursing home care is not covered by Medigap insurance, which is optional. On the other hand, Medigap policies may help with certain out-of-pocket expenses.
Medicare Part A may fund a stay in a skilled nursing facility if recovering from an illness, injury, or medical treatment.
However, a doctor must confirm that the person requires nursing care daily. In addition, the person’s benefit period must still be active.
Each benefit period, Part A, covers up to 100 days of SNF treatment. If a person has to remain longer, they will not be eligible for additional coverage.
Does Medicare Pay for long-term care?
Medicare does not pay anything toward the high long-term care costs in a nursing home or other institution.
So, who or what is it that does it? Here are a few possibilities.
- Private pay: To pay for their own or a loved one’s nursing home care, many people and families pay out of pocket or use assets such as property or investments. If those resources are depleted, Medicaid may become a possibility.
- Long-term care insurance: Depending on the conditions of their policies, some persons have long-term care insurance that may payout.
- The VA: Veterans of the military may be eligible for long-term care benefits from the United States Department of Veterans Affairs.
- Medicaid: A state and federal healthcare program that covers low-income persons pay a significant percentage of nursing-home costs in the United States. Medicaid eligibility varies by state, although all states have tight income and asset limits.
Many Americans who require long-term care apply after depleting their assets to the point of eligibility. For further eligibility information, contact your state’s Health Insurance Assistance Program.
If a person satisfies specific criteria, Medicare Part A may cover some skilled nursing care expenses in a nursing home.
If a person requires long-term custodial care in a nursing home, they will have to pay for it. However, Medicaid or long-term care insurance may cover long-term care costs.
If you want to know in what situations Medicare will cover you, contact our licensed agents specializing in Medicare. They will also assist you in finding the right plan that suits your medical needs.