Ask the Estate Planning Attorneys in Paramus, New Jersey: Will Medicare Pay for the Cost of Nursing Home Care?
Many families mistakenly believe that Medicare will
cover the cost of nursing home care and expenses when their loved one is ill
and in need of long-term health care. In this post we will examine the
circumstances in which Medicare will pay for the cost of nursing home care and
expenses and how much financial assistance they provide families seeking
nursing home care for a loved one.
What Nursing Home Care Does Medicare Cover?
Generally, there are two types of nursing home care
– custodial care and skilled nursing care. Custodial care involves helping
individuals with daily living activities such as eating, bathing, dressing, and
toileting.
Skilled nursing care involves helping individuals
who need medical care that can only be provided by a registered nurse or
licensed practical or occupational practitioner, like a speech pathologist.
Examples of medical care that can only be provided by a registered or
specialized nurse are wound care, physical therapy, respiratory therapy, or
occupational therapy.
How can My Nursing Home
Stay Qualify for Medicare Coverage?
Medicare will cover the cost of nursing home care,
for a limited time, under the following circumstances:
●
You must have had a hospital stay of
three or more inpatient days;
●
You must have available days left in your
Part A benefit period (Medicare may cover up to 100 days per benefit period);
●
Your doctor must indicate that skilled
nursing care is medically necessary to treat your condition;
●
You receive the required skilled care on
a daily basis;
●
Your nursing home stay need is related to
the condition you were treated for in the hospital or a new condition started
while you were receiving nursing home care for the ongoing condition; and
●
The nursing home facility is certified by
Medicare.
How does Medicare Help
Pay for the Cost of Rehabilitation?
When Medicare covers a nursing home stay, it is
almost always for the limited purpose of rehabilitation. Keep in mind that
Medicare will only pay for the cost of rehabilitation under specific
circumstances, like following in-patient admission in the hospital.
When an individual is discharged from the hospital,
after in-patient admission of at least three days, they may be directed to go
into a skilled nursing home facility for rehabilitation. The first 20 days of
care are typically paid by Medicare.
Days 21 to 100, however, are not covered by
Medicare. Private insurance and/or a Medicare supplement policy, after a hefty
deductible, are able to help cover the cost of the remaining days – or days 21
to 100, if the individual has private insurance and/or a Medicare supplement
policy. At least 100 days under this scenario are covered under Medicare, a
Medicare supplement policy, and private insurance.
If the individual no longer needs rehabilitation or
voluntarily stops rehabilitation, then the Medicare payments stop, followed by
Medicare supplemental insurance and private insurance. If the individual still
needs nursing home care, the families will have to look for other ways to pay
for the cost of care. One way that may be available is the Medicaid program.
Check back next month when we review how Medicaid helps pay for nursing home
care.
Medicaid can Help Pay
for Nursing Home Care
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