Medicare Part A will pay for care in a nursing home for up to 100 days if the care that is required is considered “skilled”. In order to be considered “skilled,” nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. but there are a number of requirements that must be met before the nursing home stay will be covered. If you qualify, then Medicare may cover expenses related to your nursing home care in a skilled nursing facility for the first 100 days as follows: For days 1 to 20 of your stay during the benefit period, you pay $0. For days 21 to 100 of your stay, you pay a coinsurance that is set by the government. Medicare generally doesn’t cover long-term care stays in a nursing home.
The key to understanding Medicare is that it provides reimbursement care for a specific time and is not intended to be utilized for long-term insurance coverage. The maximum benefit period is 100 days, but your medical condition may not qualify you to receive this length of coverage.
Medicare benefits apply under the following circumstances:
- The patient spends three consecutive days in an acute care hospital, not including the day of discharge.
- A physician certifies that the patient requires skilled or rehabilitative care.
Services typically covered by Medicare include:
- Patient room
- Meals, including therapeutic diets
- Nursing care
- Rehabilitation services
- Medical supplies
- Use of adaptive equipment and appliances
- Ancillary services, such as laboratory tests and x-rays
We participate in a variety of additional private insurance plans including: accepts many payer types including Medicare, Medicare HMO’s, Medicaid, Blue Cross Blue Shield, HAP, Aetna, Priority Health, AARP and many more. Each plan is different and coverage amounts may vary greatly. We are happy to sit down with you and review your plan to determine your insurance eligibility and coverage.
If you have limited assets and a low income and you need help paying for nursing home or assisted living care, Medicaid might help you pay for your care. Medicaid will generally only cover the cost of “convalescent care” or what most people refer to as “long term care”. However, before Medicaid will pay for a nursing home stay, it must be proven “medically necessary” for the patient. The rules for Medicaid are complicated, but we can help. Our admissions professionals can help answer your questions and explain what Medicaid will and will not pay for.
Every insurance plan is different and coverage and benefits vary. Please contact our Admissions and Marketing Department for more information.