Medicare pays for nursing home care for those that need skilled nursing care.
Many elderly people rely on Medicare to help them pay health care expenses. People who have qualified for Social Security disability benefits for at least two years also receive Medicare benefits. Medicare covers a range of services, including nursing home care under certain circumstances.
Medicare Part A
Medicare Part A covers inpatient care in skilled nursing facilities, often referred to as nursing homes. Patients must require skilled nursing care, however, such as intravenous drugs, complex dressing changes or physical therapy. Medicare does not cover long-term care or custodial care, such as care for patients that only need help with things like personal hygiene and meals. In order for Medicare to cover a nursing home admission, patients must have first spent at least three days in a hospital for an illness or injury related to the reason they need to be admitted to a nursing home.
Medical Necessity
A physician must state that skilled nursing care is medically necessary in order for a patient to be admitted to a nursing home. While some patients receive treatments such as intravenous medications or physical therapy in their own homes, many don't have family members who can serve as full-time caregivers and some patients require too much care for home health care nurses to meet their needs at home. Patients who can easily receive treatment at home will not qualify for admission to nursing homes, however.
Patient's Portion of Cost
Most Medicare recipients receive Medicare Part A at no cost to them. As of 2011, patients admitted to nursing homes pay nothing for the first 20 days they stay in the facility. From day 21 to day 100, they must pay $141.50 per day. Medicare covers the rest. After 100 days, patients must pay for the full cost of nursing home care. If patients have both Medicare and Medicaid, Medicaid often covers the portion of nursing home care not covered by Medicare, although Medicaid coverage does vary somewhat by state.
Medicare Part C
Some people opt to sign up for Medicare Part C instead of traditional Medicare. They choose from a number of health care plans. If you have Medicare Part C, call the number on your insurance card to find out about your nursing home benefits. They vary by plan.
If You Need Further Care
If you need further care, such as custodial care, or care extending beyond 100 days for which you have difficulty paying, you should consider applying for Medicaid. In order to qualify for Medicaid, you must have low income and limited resources, such as savings. The social worker at your nursing home can probably help you apply.
Tags: nursing home, Medicare Part, home care, nursing home care, skilled nursing, admitted nursing, health care
