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Does Medicare cover nursing homes?

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Navigating the world of Medicare can be tough, especially when considering the finer details of what this program does and does not traditionally cover. Feel free to utilize our live chat feature or call us at (800) 950-0608 for more information about Medicare coverage options.

Just the Essentials…

  • Unfortunately, Medicare is not required to fully cover the costs associated with long-term nursing home care.

  • That said, various parts of Medicare may be able to help you or your loved one pay for certain aspects of skilled nursing facility care depending on specific levels of coverage.

  • For specific questions or concerns regarding whether your Medicare Advantage plan covers nursing home care, or to explore your potential coverage options, contact MedicareInsurance.com today.

  • Even if long-term nursing home care isn’t expressly covered, you can still benefit from researching and comparing nursing home options ahead of time using an abundance of available tools.

How does Medicare affect long-term nursing home care?

Medicare is a government-managed health insurance program designed to assist people 65 or older (or those who have been diagnosed with certain disabilities or diseases) in paying for certain healthcare costs.

That said, many people are surprised to learn that Medicare does not always cover every medical expense in every situation. For example, long-term nursing home care is not typically covered (in full) by Medicare benefits.

However, there are a few aspects of nursing home costs that may be covered under certain parts of Medicare. Learn more about Medicare and nursing home coverage right here at MedicareInsurance.com.

Does Medicare pay for nursing homes?

Unfortunately, Medicare does not usually cover long-term care received in a nursing home. However, some specific plans may fund temporary care received from a skilled nursing facility or specialized inpatient care.

Keep in mind that Medicare is designed specifically to cover medical costs, not custodial care such as eating, bathing, and dressing. Typically, these custodial services are the bulk of care that is received from a nursing home and they are not usually provided by trained medical professionals.

In short, if the care received does not require a medical degree of some form to provide, Medicare is not responsible for covering the service.

How might the different parts of Medicare cover various aspects of nursing home care?

As stated, there are actually a few different parts of Medicare, each of which may cover various aspects of nursing home care in part, but not in full. Each part of Medicare is responsible for the coverage of slightly different care and treatment.

Medicare Part A

Medicare Part A, one half of what is known as “Original Medicare,” primarily covers in-hospital treatment. 

Typically, Medicare Part A will cover a person’s first 100 days of acute care received from a skilled nursing facility, so long as the facility is Medicare-certified and the patient enters the skilled nursing facility following a hospital stay of at least three days.

Some short-term services Medicare Part A may cover in a nursing home environment include: 

  • dietary counseling and nutrition services
  • medical supplies and equipment
  • medications received while in a hospital setting
  • Meals received during short-term recovery
  • occupational therapy
  • physical therapy
  • semi-private room
  • skilled nursing care, such as wound dressing changes
  • social work services related to medical care
  • speech-language pathology
  • ambulance transportation

Under Medicare Part A, there may be additional payments due depending on the duration of one’s stay in a skilled nursing facility. These payments are as follows:

  • Days 1-20: Medicare Part A covers the full amount of care. The beneficiary pays nothing.
  • Days 21-100: Medicare Part A continues to cover costs and the beneficiary pays a $185.50 coinsurance payment per day for each benefit period.
  • Days 101 and beyond: Beneficiary must pay for the full cost of treatment.

Medicare Part B

Medicare Part B, the second half of Original Medicare, primarily covers outpatient services like doctor’s appointments and health screenings. As a result, Part B does not typically apply to care received from a nursing home facility.

Medicare Part C

Medicare Part C, also known as Medicare Advantage plans, are provided by private insurance companies. Though coverage and benefits may vary, Medicare Advantage plans usually do not cover long-term custodial nursing home costs.

Depending on your exact plan and provider, there may be some exceptions to this. For example, Medicare Part C may pay for healthcare or prescription medications while a person stays in a nursing home, depending on their exact plan.

Feel free to contact MedicareInsurance.com today for more information about potentially available Medicare Advantage plans in your area.

Medicare Part D

Medicare Part D is responsible for providing prescription drug coverage. Like Medicare Advantage, Medicare Part D plans are optional additions to health insurance coverage. These plans may be offered as part of a Medicare part C plan, or as standalone options.

If you or your loved one has Medicare Part D, your medications will typically be covered even if you live in a long-term care facility.

Medigap

Medigap plans are optional supplemental plans that are also offered by private insurance companies. They are designed to help pay for some out-of-pocket costs, like deductibles and copays.

Certain Medigap plans may offer additional coverage for skilled nursing facility coinsurance in exchange for an extra monthly premium. In fact, some Medigap plans may pay for up to 75 percent of coinsurance costs. However, this amount only applies to skilled nursing facility care, not custodial nursing home care.

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What if myself or my loved one eventually requires nursing home care?

Although Original Medicare does not traditionally cover custodial services received in a long-term nursing home facility, there may still be some options that can help you afford this type of treatment. 

Moving into a long-term retirement community or nursing home can still be a smart option for you or your loved one once full-time care begins to be required on a regular basis. For this reason, it can be extremely important to adequately research and compare nursing home facilities in your area before you or your loved one requires it. 

Choosing the ideal nursing home may seem overwhelming, but thanks to an abundance of great tools, it doesn’t have to be. Looking into nursing home reviews and comparing facilities can be incredibly beneficial.

Do you have additional questions regarding nursing home coverage options under Medicare Advantage? If so, don’t hesitate to contact us online via our live chat feature, or by phone at (800) 950-0608 to speak with a licensed agent!

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