Many seniors wonder how and if Medicare covers nursing home care. In many cases when someone is asking this question it’s too late; since they probably have medical issues keeping them from getting a Long-Term Care plan.
If you don’t need nursing care and you’re just planning for the future; long term care insurance can help protect you in the future if and when you need nursing care.
How Medicare Covers Nursing Home Care
Original Medicare could cover the expenses to skilled nursing care or skilled nursing facility. Medicare allows for coverage at 100% for the first 20 days in a skilled nursing facility; then, a daily copay for days 21-100 of your stay.
From day 101 plus you are responsible for all costs. Having a Medigap policy can mean getting out of pocket costs lower. When it Comes to nursing home care, there are two categories; skilled nursing care and custodial nursing care.
Skilled Nursing Care
This is care is given by staff such as a physical and occupational therapist. This care includes physical, respiratory, or occupational therapy, as well as sterile bandage changes and wound care.
These are all services under Part A for a limited time, with certain conditions when treatment is given in a skilled nursing facility.
For Medicare to cover, the following requirements must be met
- Have a hospital stay of three or more inpatient days
- days left over in your benefit period for Medicare Part A
- Need the required care on a daily basis
- Your doctor must determine that skilled nursing care is required to treat your conditions and be considered medically necessary
- Stay must be in conjunction with the condition
- The facility must be certified and accept Medicare
Help with daily activities like bathing, dressing, eating, and using the bathroom facilities. These care services don’t usually have coverage. To have coverage for this kind of care you will need long-term insurance. This type of coverage can help cover both unskilled and skilled care.
Medicare Plans Help Cover Cost
Medicare Supplement plans will help cover your portions of cost left over by Medicare. However, depending on which Medicare Supplement you choose you could have little or no cost out of your own pocket for the care.
A Medicare Advantage Plan is required to cover at least the same benefits as Original Medicare. Since these plans replace Medicare, they must offer 100 days in a skilled nursing facility.
Other Assistance for Nursing Home Care Costs
If you need nursing care after benefits end, check your state to see about Medicaid. To find out if you qualify for Medicaid you can contact the State Health Insurance Assistance Program (SHIP) or your state Medicaid office. You can use this tool from Medicare to help you find the local office by clicking here.
Another option to explore is asking your doctor about home health services instead of skilled nursing care. There are some conditions in which Part A and/or B could cover home health services. These home health services could include physical therapy and occupational services.
What Can I Do to Ensure I Have Coverage for a Nursing Home
The best way to ensure coverage for nursing care is by purchasing a long-term care plan. These plans let you select a per month benefit to help pay for nursing home care.
There are several additional options to add to these plans such as inflation protection, because we all know $100 bucks today is not going to cover the same in 10 years, as well as different elimination periods before the plan starts paying.
Don’t make the same mistake thousands of seniors make by waiting too long to enroll. For more information on how a Medicare Supplement or long-term care plans call the number above or fill out an online rate form.