Does Medicare Pay For Nursing Homes?

Does Medicare Pay For Nursing Homes? – Overview

Medicare in the US is a federal health insurance program for people aged 65 and older and certain younger people with disabilities or specific medical conditions.

Medicare does not cover long-term stays in nursing homes. Medicare Part A (Hospital Insurance) covers skilled nursing care in a skilled nursing facility under certain conditions for a limited time.

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However, specialty plans may cover temporary stays in a skilled nursing facility (SNF) if someone requires specialized care.

According to Medicare, nursing home care should be either skilled or custodial.

Medicare is divided into four parts covering different healthcare services: hospitalization, outpatient care, and prescription medicines. It can be easier to seek and get healthcare if you know what each plan covers.

This article examines how Medicare can assist with some nursing home costs, what assistance is available for hospice care insurance, and how to locate a nursing home.

Hospitalizations, outpatient services, and preventive care are all covered under the programs.

Medicare pays for short-term nursing homestays to meet the need for specialized care.

However, Medicare usually does not pay if a person wants to stay in a nursing home for an extended period.

On What Condition Does Medicare Pay Nursing Home Stay?

Does Medicare Pay For Nursing Homes – Medicare Requirements

If you first understand what Medicare doesn’t cover, it will be easier to understand what it covers at a nursing home.

Medicare doesn’t cover the cost of nursing home care when a person only requires custodial care. The following services are included in custodial care:

Bathing
Dressing
Eating
Going to the bathroom

So, what does Medicare cover? Let’s discuss this in detail.

Medicare Requirement To Cover A Nursing Home Care

Medicare will pay for skilled nursing care in a nursing home facility if you meet specific criteria. Here are a few of them:

You must be a Medicare Part A beneficiary with days remaining on your benefit period.
You must have first completed a required hospital stay.
Your doctor must determine that you require skilled nursing care. The care should be qualified and provided by a physician or a healthcare professional like a registered nurse, physical therapist, or licensed practical nurse.
You’ll need to go to a skilled nursing facility for treatment, and care must be provided daily.
You must obtain your services at a Medicare-certified facility.
You require professional services for a hospital-related medical condition or a condition that developed while you were receiving treatment for the original hospital-related medical condition in a skilled nursing facility.

It’s also worth mentioning that this is merely a temporary fix, not a permanent one.

Generally, Medicare Part A may cover 100 days of skilled nursing home treatment.

The condition is that one must be admitted to a skilled nursing home within 30 days of being discharged from the hospital, and they must be admitted for the disease or injury due to which they were receiving hospital care.

Note: Medicare should also provide care coverage that doesn’t require skilled nursing but does require qualified supervision.

Under What Conditions Does Medicare Pay for Nursing Home Care?

Medicare usually covers short-term skilled nursing care in a nursing home.

Part A of Medicare

Medicare Part A usually covers the following services in a nursing home setting.

Dietary counseling and nutrition services
Skilled nursing care
Swing bed services
Social work medical services
Medical supplies and equipment
Dietary counseling and nutrition services
Speech-language pathology
Meals
Occupational therapy
Medications
Physical therapy
Semi-private room

Under the abovementioned conditions, a person receives skilled nursing facility care in an acute-care hospital. The Medicare Part A deductible for 2024 is $1,632 per benefit period.

Part B of Medicare

Outpatient treatments, such as doctor’s visits and health screenings, are covered. However, nursing home stays are frequently not covered under Medicare Part B.

Do Advantage Plans Cover Nursing Home Stays?

Medicare Advantage or Medicare Part C typically do not cover custodial care in nursing homes, except when a person’s health insurance plan has a contract with a particular nursing home or organization running nursing homes.

Before visiting a nursing home, always check with your plan provider to see what treatments are and aren’t covered under your Medicare Advantage plan.

Medicare Advantage Part C has all the benefits of Medicare (Parts A and B).

Many Medicare Advantage plans, unlike Original Medicare, include fees for vision, hearing, and dental care, as well as prescription medicines.

Your coverage may also include nursing home care, depending on which Medicare Advantage Plan you choose. Let’s look at it more closely.

Nursing Home Care and Medicare Advantage

Since it does not cover custodial care, Medicare does not generally cover nursing home care.

However, according to the official US government website for Medicare, most nursing home care is considered custodial care, described as assistance with daily tasks such as eating, dressing, bathing, and using the restroom.

According to Medicare, SNF care is defined as care that qualified professionals must provide to be safe and effective.

Changing sterile bandages and delivering intravenous antibiotics are two examples.

In 2024, the skilled nursing facility coinsurance for days 21-100 is $204 per day of each benefit period. This amount can change annually, so it is essential to refer to the current year’s Medicare costs.

Who Foots The Bill 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 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 people have long-term care insurance that may pay.

The VA: military veterans 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 who qualify to 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.

In need of nursing home care? If you need coverage for nursing homestay care, you can avail of the Medicare Advantage Plan, which is categorized into six types. These six main types of plans include:

HMO Plans or Health Maintenance Organizations

PPO Plans or Preferred Provider Organization () plans

PFFS plans or Private Fee-for-Service

SNP Plans or Special Needs Plans

HMO Point-of-Service (HMO-POS) plans

MSA Plans or Medical Savings Accounts

SNP Plans or Special Needs Plans

SNP is the one that matters in the context of nursing home care. SNPs come in a variety of shapes and sizes.

Institutional SNPs (I-SNPs), according to the Centers for Medicare & Medicaid Services, institutional SNPs (I-SNPs) are specifically created for persons requiring various types of qualified long-term care.

The availability of SNPs varies by region, as per the official Medicare website of the United States government.

For example, some companies provide SNPs to all Medicare beneficiaries in a particular state, while others only offer them in specific counties.

Additionally, one provider may offer numerous SNPs, while another may only offer a single plan.

Furthermore, an SNP available last year may not be functional this year, as insurance firms can join or leave Medicare every year.

According to the official Medicare website of the United States government, all SNPs provide prescription drug coverage.

In addition, of course, they provide coverage comparable to Medicare Part A and Medicare Part B.

Medigap Supplements:

As of 2024, Plans C and F are not available to newly eligible Medicare beneficiaries. Only those eligible for Medicare before January 1, 2020, can buy these plans.

Co-insurance: Some Medigap plans like C, D, F, G, M, and N may cover Co-insurance for skilled nursing care facilities.

Plans are among them. Plan K covers approximately half of the co-insurance, whereas Plan L covers the other half.

On the other hand, long-term nursing home care is not covered by Medigap supplement insurance.

Prescription drug coverage is typically provided under Medicare Part D or Medicare Advantage plans.

Best Medicare Plans For Nursing Home Care:

Most Medicare plans don’t cover nursing home care. However, acquiring a Medicare Advantage plan with a special arrangement with a nursing facility may make you eligible for an exception. Medicare requires a qualifying hospital stay of at least three consecutive days before covering skilled nursing facility care.

Ways to Assist In Paying For Nursing Home Care:

There are choices outside of Medicare that may assist in offsetting some costs if you or a loved one needs long-term nursing home care. These are some of them:

LTC insurance: It’s a type of long-term care insurance. This could assist in paying for all or part of the costs of a nursing home.

Many people buy this insurance when they are younger, in their 50s, because rates typically rise as they age.

Medicaid: It’s a government-run healthcare program for low-income people with state and national programs that assist in paying for nursing home care.

Administration for Veterans Affairs: Here, retired military personnel may be eligible for financial help for long-term care services from the US Department of Veterans Affairs.

Some people may require Medicaid services after exhausting their financial resources to pay for long-term care.

What is a Nursing Home?

A nursing home facilitates patients’ residency and treats them in-house, and residents can get additional care from nurses or nurses.

Nursing homes are most likely homes or apartments for persons who require further daily medical care and cannot be left alone.

Some provide beds, showers, standard restrooms, recreation, relaxing, and dining areas.

Most nursing homes provide 24/7 care services, including assistance with the restroom, prescription assistance, and meal services.

Nursing Home Care Advantages

There are several benefits of nursing home care that people can enjoy, which include:

Nursing home care typically enables people to live independently without performing household tasks such as grass mowing or home maintenance.
Many nursing homes also offer social activities that allow residents to keep friendships and participate in other activities.
Having access to needed nursing services and qualified people on hand to supervise a person can comfort them and their family.
Nursing homes are secure and can be especially helpful for patients who need special care to stay safe.

Nursing Home Care Cost

According to Genworth’s 2023 Cost of Care Survey, the national median cost for a private room in a nursing home is $9,403 per month, while a semi-private room costs $8,390 per month.

The cost of a private room in a nursing home can vary widely depending on the location and the level of care needed. For accurate and up-to-date information, the figure mentioned should be verified with the latest data from a reliable source like Genworth’s annual Cost of Care Survey.

Likewise, the national median cost for assisted living facilities is $4,774 per month in 2023.

Nursing home care is costly; rising prices are attributed to the treatment of increasingly sicker patients, employee shortages, and increased restrictions that drive up costs.

How to Assist a Loved One Enrolling in Medicare

If you have a loved one approaching the age of 65, here are some suggestions for how you might assist them in enrolling:

You have three months before your loved one turns 65 to begin the process. Starting early can help you acquire answers to essential concerns and reduce stress during the process.
Visit the official website of the Social Security Administration to find a location near you.
Talk to your friends and family to see whether they’ve gone through anything similar. They can offer advice based on what they learned while enrolling in Medicare and, if necessary, pick supplement plans.

Conclusion

Medicare Part A covers skilled nursing care in a nursing home setting, provided a person fits specific criteria.

In case of a need to live in a nursing home for a long time to receive custodial care and other services, you’ll almost certainly have to pay out of cash or rely on long-term care insurance or Medicaid.

However, if a person satisfies specific criteria, Medicare Part A may cover some of the costs of skilled nursing care in a nursing home.

If a person requires long-term custodial care in a nursing home, they must pay for it out of pocket. However, Medicaid or long-term care insurance may cover long-term care costs.

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Does Medicare Pay For Nursing Homes?