Medicare covers limited, short-term nursing home care. This means that more likely than not, the kind of nursing home care you’re looking for isn’t covered. However, let’s break this down and make sure you understand what’s included in your Medicare coverage.
An Intro to Medicare and Nursing Home Care
Medicare provides health insurance coverage to individuals aged 65 years and older and those who have received at least 24 months of Social Security Disability Insurance (SSDI). There are a few different Medicare plans available, but the main two you should concern yourself with for nursing home care coverage are Medicare Part A and Part B.
Part A and Part B, or Original Medicare, cover hospital and general medical costs. This includes checkups, diabetes treatment, and many other services.
This coverage is absolutely essential, but there are a number of limits and requirements on certain benefits.
Requirements for Medicare Coverage
To receive coverage for nursing home care, it must meet certain requirements:
- Your visit must be considered short-term. You only receive full coverage for a certain number of days in a skilled nursing facility, then you’re responsible for out-of-pocket costs called coinsurance. These fees are broken down like this:
- Days 1–20: $0 coinsurance per day.
- Days 21–100: Up to $194.50 coinsurance per day.
- Days 101 and beyond: All costs.
- Your care cannot be custodial. It will not be covered if it’s not directly treating your specific, covered medical condition. This includes care such as:
- Bathing
- Dressing
- Eating
- Going to the bathroom
- It should fall under Part A, not Part B. Medicare Part B covers outpatient services, such as doctor’s visits and health screenings, and won’t cover your nursing home stay. Some services in the home may be covered, but the stay itself won’t.
You also need to meet a few requirements:
- Since Part A primarily covers hospital care, you must have first had a qualifying hospital stay.
- You have a limited number of days with allotted coverage for hospital care. So, you must have Medicare Part A and have days left in your benefit period.
- You must require daily, skilled nursing care for your treatment as decided by your doctor.
- You must receive care at a Medicare-certified skilled nursing facility.
- Your treatment in the facility must be related to the condition that put you in the hospital.
Take the Right Steps with ReLion
Understand your coverage and how to navigate Medicare with the right help. To see your options, call ReLion Insurance Solutions at 858-999-2858.
