Does Medicare Cover Nursing Home Care?
I've often spoken with people who've asked me a simple question, “Does Medicare Cover Nursing Home Care?”
If you or a loved one is on Medicare and would benefit from living in a nursing home facility, there are several rules that you should know about. At this current time, the only Medicare insurance that might cover nursing home care is Medicare Part A. In order to qualify, you must meet certain medical care requirements.
Information about Nursing Home Care and Medicare Part A
Does Medicare Cover Nursing Home Care such as Skilled Nursing Facility Care?
Medicare Part A covers general services provided in skilled nursing facilities. This includes daily meals, skilled nursing care, physical and occupational therapy as needed, ambulatory transportation, prescription medications, any use of the equipment and/or medical supplies while staying in the facility, and dietary counseling when needed. Medicare also covers speech-language pathology services during your stay.
Keep in mind that you must have a 3-day hospital stay as an inpatient in order for Medicare to cover your stay. Also, after 20 days, you'll have a copay.
So in this case, Medicare DOES covers skilled nursing care.
Does Medicare Cover Nursing Home Care Such as Custodial Care?
When people ask me, “Does Medicare cover Nursing Home Care?” I always have to ask what that means. This is because Medicare does NOT cover custodial care. Custodial care is also known as activities of daily living or ADLs. These include:
If your loved one needs help in these areas, Medicare won't pay. You'll have to pay for custodial care another way. And many people aren't aware of that.
So In the instance of custodial care, Medicare does NOT cover nursing home care.
There are three basic ways to cover custodial care. Those are:
- Private Pay you cover the costs.
- Long Term Care Insurance- but you cannot get this if you need it now. You'll need to have purchased it when you were not in immediate need.
- Medicaid– if you meet certain qualifications, your state may assist you with paying for nursing home or custodial care through their Medicaid program.
Helpful Tips on Locating a Nursing Care Facility:
See What Insurance Might Cover
Some services might be covered. For example, if your loved one needs home health care, then this might be covered by Medicare. Find out what, if any, insurance plans might be accepted for different services at that particular nursing facility.
What is the facility's current occupancy?
Find out how many beds are there and what percentage is occupied.
Check out Reviews of the Facility
Make sure to get online and research what other people and their families think about the nursing home. That way, you'll have a better understanding of how well they treat those staying there and what their personal experience was like. Be sure to read about any complaints that previous occupants made about the facility.
Find Out the Rules and Regulations of Nursing Home
Ask to see their rules and regulations, then you'll have a better understanding of what is expected of the occupants. Some communities are not equipped to handle certain behaviors or conditions.
Check it out personally.
In order for you to truly find out what the facility is like, set up an appointment to go there and check it out for yourself. This way you can see how clean it is and get a feel for the staff as well. While visiting, socialize with others that are staying there and get their own personal opinions about the place. It's wise to take along a family member or loved one who can assist you along the way.
Research Medicare Approved Facilities
If you think that your loved one might qualify for Skilled Nursing Care paid for by Medicare, nip it in the bud, do some online research of nursing homes who accept Medicare. Go to https://www.medicare.gov/nursinghomecompare/search.html and compare.
See What Health Services They Can Handle
Depending on your own personal health, it is wise to inquire about the health services in which are provided at the nursing care facility. Some don't provide any medical services, while others provide medication management, injections, etc.
By following these simple steps, the process of finding an ideal nursing home should go a little more smoothly for you.