Medicare and most health insurance plans don't pay for long-term care in a nursing home. Even if Medicare doesn't cover the care you receive in a nursing home, you'll still cover it. As we age, the more help we need to take care of ourselves. Today, assisted living is a necessity for millions of Americans. These specialized nursing homes allow older people to live independently and, at the same time, provide them with the help they need.
Whether you're looking for care for yourself or a loved one, there are a lot of things to consider. And cost is one of the most important factors. Medicare Advantage can also help offset some of the cost of long-term care. Also known as Part C, these plans are offered by private insurance companies and include combined benefits for things not covered by Original Medicare. And while the Medicare Advantage plan doesn't cover room and board in an assisted living facility, some now include benefits related to long-term services, such as in-home patient support and adult day care.
You can also use your life insurance policy to pay for assisted living. Before making any decisions about your long-term care, talk to someone you trust (such as a family member or your healthcare provider) to understand your options. If you're not sure about the long-term care benefits included in your Medicare Advantage plan, contact a member of the Wellcare team. Our experts can help you identify long-term care coverage options that are right for you. Yes, Medicare Part A can partially cover up to 100 days in a nursing home if specialized nursing care is required.
Medicare will not cover stays longer than 100 days and will not cover a nursing home stay at all if skilled nursing care is not needed. Medicare Part B covers outpatient expenses and doesn't cover a nursing home stay. Privately purchased Medicare Advantage plans (Part C) vary widely in terms of coverage, but they generally only cover short-term stays in a nursing home if someone needs specialized nursing care. In many cases, there is no need to move to another nursing home when the source of payment changes to Medicaid NF. Many nursing homes are also certified as Medicare skilled nursing facilities (SNF), and most accept long-term care insurance and private payments.
For example, a person will usually be admitted to a Medicare SNF after a hospitalization that qualifies them for a limited period of SNF services. If nursing home services are still needed after the SNF coverage period, the person can pay privately and use any long-term care insurance they have. If the person exhausts their assets and is eligible for Medicaid, and the nursing home is also a Medicaid certified nursing facility, they can continue to reside in the nursing home with the Medicaid NF benefit. If the nursing home is not Medicaid certified, you will have to move to an NF in order to receive the Medicaid NF benefit.
You may be eligible for Medicaid coverage in a nursing home, even if you haven't qualified for other Medicaid services in the past. Ask your plan about nursing home coverage and check the facility's quality ratings before making any reservations to enter a nursing home. If you're enrolled in a Medicare Advantage (Part C) plan (such as an HMO or PPO plan) or another Medicare health plan, check with your plan to see if it covers nursing home care. It is advisable to explore all available options and plan for the costs of care in a nursing home, especially if long-term care is envisaged.
With the many threats currently facing the Medicare program, now is the time to come together as partners and explore ways to advocate for comprehensive Medicare coverage, health equity and quality health care. Because this type of personal care is not medical, it can be provided by caregivers and does not require the presence of a nurse or doctor. State Medicaid programs require that NF services be provided by state Medicaid programs to people 21 years of age and older who need them. Even if Medicare doesn't cover care in a nursing home, you'll need Medicare to cover hospital care, medical services, medications and medical supplies while you're in a nursing home.
It should be noted that Medicare only pays for up to 100 days of care in a skilled nursing facility during each benefit period. However, you don't have to pay the Part A deductible for care at a skilled nursing facility if you already paid for the care you received at a hospital during the same benefit period. This type of insurance policy can help you pay for many types of long-term care, including specialized and non-specialized care. You may not need a minimum 3-day hospital stay if your doctor is involved in a responsible care organization or other type of Medicare initiative that has approved an exemption from the 3-day rule in skilled nursing facilities.
Be sure to visit the NCOA BenefitsCheckUp to look for other benefit programs that can help you pay for health care, food, prescription drugs, utilities and other basic living costs. Most nursing home care is custody care, which helps you to carry out activities of daily living (such as bathing, dressing, going to the bathroom and eating) or to meet your personal needs safely and reasonably without knowledge or professional training.
