Does Medicare Pay For Nursing Home?

Does Medicare Pay For Nursing Home?

Usually, Medicare does not cover long-term care. This is often provided at home, in the community or in other types of facilities, like nursing homes, assisted living facilities as well as assisted living communities. A nursing home is a private institution that provides property accommodations along with medical care, particularly for the senior individuals.

Some short-term stays qualify

Medicare Part A, the component of original Medicare that includes hospital insurance, does pay for short-term stays under specific, limited circumstances in skilled nursing facilities. Your doctor may send you to a skilled nursing facility for a higher level of care and rehabilitation after a hospital stay.

Original Medicare can cover a portion of the cost for up to 100 days in a skilled nursing facilities. 
You are to be admitted to a skilled nursing facility within 30 days after leaving the hospital for the same illness, injury or a related condition.

What is a “qualifying hospital stay”?

A qualifying hospital stay means that you were formally admitted as a hospitalized patient for 3 consecutive days. Being in observation¨ does not qualify.

When you enter a hospital you should ask if you are being formally admitted or for observation only. In case of being for observation, there is the possibility that you may want to turn to your doctor to see the possibility of changing your status to hospitalized patient.

There is 2 more things you should know about the 3 day rule:

1. Medicare Advantage plans often don´t have the same restrictions for enrollees. You should check with your plan provider on terms for skilled nursing care eligibility requirements.

2. The only places that have to obey this rule are skilled nursing facilities. 

If you’re discharged from the hospital to another type of facility, such as a rehabilitation hospital, then Medicare will cover you under certain rules. 

If you qualify for short-term coverage in a skilled nursing facility then Medicare covers 100% of the medical costs including meals, nursing care, room, etc. only for the first 20 days. From the 21st to 100th day you will be responsible for the daily copay, which is $185.50. 

In case you stay in the facility for more than 100 days, then you´ll be responsible 100% of the costs, unless you count with another type of insurance, like Medigap policy, that covers it. 

• Private pay: Several people as well as households merely pay out of pocket assets such as a residential or commercial property or financial investments to fund their very own loved ones’ assisted living facility treatment. In case they consume those sources, Medicaid might end up being an alternative. 
• Long-term care insurance: Several individuals own long-term care insurance which may cover the costs, depending on their policies’ terms.
• The VA: Military veterans may possibly have easy access to long-term care benefits from the U.S Department of Veterans Affairs.
• Medicaid: The state as well as the federal healthcare system that offers insurance coverage to low-income individuals that qualify, pays off a significant amount of America’s assisted living facility expenses. Medicaid qualification can vary by state, however, it calls for strictly limited income as well as financial assets. 

Does Medicare pay off the costs of nursing homes?

The healthcare program in the U.S, Medicare, is for those 65 years old or older who additionally have certain clinical conditions.

Said program pays for healthcare facility stays and outpatient services as well as preventative treatment. Medicare doesn’t pay for long-term nursing home stays, however, it will possibly pay for short-term stays when a person is in need for skilled care.

What do Medicare parts A, B and D cover?

What about Advantage Plan (Part C) and Medigap supplements?

Plan C ——- In general, this plan will not pay nursing home costs. There is the possibility that the insurance may cover your expenses in the event that the insured has a contract with a medical center or organization that operates other centers.

Medigap supplements ——- These plans are generally sold by private insurers and they help cover any additional costs, such as deductibles. Some Medigap plans that help pay for skilled nursing facility insurance are Plan C, D, F, G, M, and N.

Plan K is responsible for about 50% of the insurance, while Plan L takes care of 75%.
However, Medigap supplemental plans will NOT pay for long-term care services.

Other questions you may have:

1. What happens when Medicare stops paying for nursing home care? As stated before, Medicare will pay your medical expenses for the first 20 days. After day 20, you will have to pay for your medical care.
2. What is the difference between a skilled nursing facility and a nursing home? The biggest difference between nursing homes and SNF is the type of care each one of them can offer you and the period of time you can stay in them.
3. What services are considered long-term care? Long-term care services are activities of daily living like, baths, restroom use, dressing, grooming, etc. it also includes community services like meals, adult care and transportation services.

If you have more questions or you want more information about Medicare, contact Antonio Espino Insurance. We are ready to answer your questions and offer you the best Medicare plan that suits you.