Medicare and health insurance in general can be confusing. Sometimes what’s covered and what’s not covered and at what rates can comes as a surprise. A common point of confusion is skilled nursing facility care and nursing home coverage.
Skilled Nursing Facility Care
If you look at the list of benefits covered by medicare Part A on medicare.gov, you will see nursing home care and skilled nursing facility care. However, these terms are a little misleading.
Really what Medicare means by this, are rehabilitative and recovery facilities for after an illness or injury. These facilities must be preempted by a hospital stay and require a doctor’s approval.
Medicare does not cover any type of long term or custodial care. So a long term condition, like Alzheimers would not qualify for skilled nursing facility care covered by medicare.
If you do need skilled nursing facility care, you must first be admitted to a hospital and then received a doctor’s orders to recover in a nursing facility or home. Your stay in the nursing facility must begin within 30 days of being discharged from the hospital.
For the first 20 days, there is no cost. After that, the costs are Up to $194.50 coinsurance per day. If your stay extends 100 days, you are responsible for the full costs.
You can, of course, purchase a Medicare Supplement Plan to offset or cover these costs if you so choose. Many medicare advantage plans will also cover SNF.
While in the nursing facility, you will receive rehabilitative services, such as physical, occupational, or speech therapy. Additionally, your care will consist of skilled nursing treatment that require medical training.
What Will Will Medicare Cover?
There are many services covered by Medicare. Benefits include:
- A semi-private room
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Medical supplies and equipment
- Ambulance transportation (when medically necessary)
- Dietary counseling
What Will Medicare Not Cover?
Medicare coverage for a skilled nursing facility does not include:
- Television, radio, or telephone
- A private nurse
- A private room (except when medically necessary)
If you are in a nursing facility only because you are unable to feed, clothe, bathe, or move yourself, even if these conditions are a result of your recent hospitalization, you are not eligible for Medicare Part A coverage. However, if you need part time help, Medicare may cover home health care.
Also, if your condition is long term, you would not qualify for skilled nursing care under Medicare. Once you each 100 days, you would be responsible for the entirety of the costs. For long term conditions, you can look into long term care plans.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.