Medicare & Nursing Care: An Overview

Generally speaking, Medicare does cover skilled nursing care if it is for a short term. However, it comes with several limitations.

 

A person might be eligible for Nursing coverage under Medicare if he/she fulfills the below criteria:

 

Is enrolled in Part A Medicare

Has inpatient stay for 3 consecutive days least, counting the inpatient-admission day to a hospital, however not counting discharge date, prior to taking the nursing home care.

Selects a nursing home that’s approved by Medicare.

Begins his/her stay inside 30 days after being discharged from qualifying 3-day stay in the hospital.

Requires the services regularly (Exceptions below).

The service is supervised/offered by the right person.

The person’s physician has ordered skilled nursing care on his/her behalf.

 

The person requires the service for either one of the things below:

 

  1. a hospital-associated disorder which was treated while the 3-day qualifying hospital stay was one

 

  1. a condition was aroused in a nursing facility while the person was treated there for the hospital-associated condition

 

Special Case: If a person is in a nursing facility for rehabilitation purposes instead of a skilled-nursing-care, then the requirement for ‘daily basis”  can be more flexible.

 

So, if a person is getting a treatment (like occupational treatment) just a couple of times per week, then it will be counted as a daily care by Medicare if the person has the therapy each time it is offered to them. If the person refuses it, Medicare won’t compensate for their stay in the nursing home.

 

Nursing home-care services that are covered under Medicare:

 

As long as you meet the requirements, Part A Medicare includes:

 

Meals

Physical, speech or occupational therapy

Some prescription medications

Medical supplies, social services, and equipment

Ambulance transport to essential services

Nutrition therapy (for people with kidney disorder)

 

The above are just a few examples of the services covered by Medicare.

 

Things That Are Not Covered:

 

Part A & B Medicare won’t pay for:

 

Private rooms

Services offered by a facility which isn’t originally approved by Medicare

Custodial care like help bathing or bathing), in case it’s the only care required by a person

Your nursing home costs in 2018:

Medicare normally pays the entire amount for the initial twenty days of your covered nursing home-care.

Get a quote for a 2019 supplement @ https://www.medisupps.com/medicare-supplement-plans-2019/

During Day 21 to Day 100: Co-insurance of $167.50/day of every benefit period. The enrollee will pay the co-insurance for every additional day during the benefit period.

 

If a person stays in the skilled nursing care for over 100 days during each benefit term, Medicare will discontinue the coverage for his/her nursing home service. (The period of benefit will terminate when a person does not receive any in-patient hospital care. This also includes nursing care, for two months in a row.)

 

A few Medicare Supplement Plans can pay for your nursing home service. Even if the care is covered by your Medicare plan, there will be still a certain cost which you’ll need to pay. A supplemental plan might help you cover up these costs.