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Does Medicare Cover Nursing Home Care?

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Are you wondering if Medicare covers nursing home care? Many people are concerned about how to pay for long-term care if they need it.  It is important to understand the role Medicare plays in covering nursing home care. While Medicare does provide some coverage for the nursing home, there are strict limits on what it will cover and how much it will pay. 

What Does Medicare Cover

Medicare does pay for some nursing home care but it is within very strict limits

Medicare is a federal health insurance program for seniors and certain disabled individuals.  It does pay for some nursing home care, but it is within very strict limits. Medicare Part A provides coverage for a limited period of time in a skilled nursing facility for people who are discharged from the hospital after a stay of at least three days. This coverage pays for a semi-private room, meals, skilled nursing, and other related services and supplies when having rehabilitative services. 

Medicare Part B covers outpatient care in a skilled nursing facility, such as physical, occupational and speech therapy. The coverage also includes medically necessary medical supplies, such as casts and splints. This type of coverage is only available if your doctor has prescribed the services, medically necessary, and provided by an approved provider. 

In most cases, Medicare will not cover long-term nursing home care. In addition, even if you do meet the criteria for coverage, the benefits are often limited in scope. Therefore, many seniors either pay out-of-pocket for a portion of their nursing home care costs, qualify for Medicaid, Veteran’s benefits, or possibly qualify for other very limited options.

What Does Medicare NOT Cover

Medicare does NOT cover long-term nursing home care. It will pay only for a very limited period of skilled nursing care when receiving rehabilitation following a hospital stay as described above. It’s important to note that this skilled nursing care must be ordered by a doctor, and the care must be provided in a Medicare-approved facility. In addition, Medicare does not cover custodial care, which is the type of help most people need in a nursing home setting, such as bathing and dressing. Nor does it cover personal care services like meals, housekeeping, and transportation. As with any health insurance plan, there are also deductibles, coinsurance, and copayments you will be responsible for. Ultimately, you are responsible for any costs that Medicare does not cover.

Medicaid is a federal and state-funded program that provides health coverage to low-income or when their assets appear low enough for qualification. Medicaid can be used to pay for long-term nursing home care and some other types of care, such as home health care and respite care. In order to qualify for Medicaid benefits, you must meet certain eligibility requirements. These include being a U.S. citizen or legal immigrant, having a valid Social Security number, and being a resident of the state in which you are applying for benefits. There are also financial requirements.

Depending on your needs and the services offered by your state, you may be able to receive certain services at home or in a nursing home. In most cases, Medicaid pays for all or part of the cost of nursing home care above most of your income, such as Social Security. It is important to note that not all nursing homes accept Medicaid payments. To determine if the nursing home you are considering accepts Medicaid, contact the facility directly.

Get Professional Advice

Navigating the maze of Medicaid and Medicare for nursing homes can be a daunting task. It is essential to differentiate between the two programs and understand what each covers. The Medicaid programs differ in qualification requirements.  The good news is that you do not have to go through this alone. The experienced attorneys at Paths Law Firm can help you make sense of the complexities of Medicare and Medicaid and determine which program best suits your needs. We can also provide legal guidance on long-term care planning, helping to ensure you are adequately protected both financially and medically. Contact us today to learn more about how we can help you get the coverage you need.

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