Medicare covers some forms of nursing home care but will not cover custodial care if that is the only care you need. There are other ways to help pay for nursing home care if you need it.
Custodial Care
What many people think of as nursing home care is custodial care. Custodial care is help with the activities of daily living. These include things like eating, bathing, dressing, using the restroom, and more. Those needs do not require professional skills or training. When you only need custodial care, Medicare will not cover these services. You may be able to find coverage if you need skilled nursing care in addition to a few activities of daily living.
Skilled Nursing Facility Care
Skilled nursing facility care is covered under Medicare Part A if certain conditions are met. This coverage is for a short-term, limited period and applies if you have days left in your benefit period to use and if you have a qualifying hospital stay. This means that the skilled nursing care you receive must be related to an injury or condition you received hospital care for, although this qualification has been adjusted during the COVID-19 pandemic in certain cases. Your doctor must also have decided that you need daily skilled nursing care, and you must get these services in a skilled nursing facility that’s certified by Medicare.
Under Medicare Part A, you pay the Part A deductible, which must be paid each benefit period. In 2022, this deductible is $1,556. You will also pay nothing in coinsurance for days 1 – 20 of each benefit period for your skilled nursing care. For days 21 – 100 of the benefit period, you pay a coinsurance of $194.50 per day. For day 101 and beyond of a given benefit period, you owe all costs.
Paying for Nursing Home Care
Medicare does not cover long-term stays in a nursing home but will cover skilled nursing care related to an injury or condition sustained during an inpatient stay in a hospital if you have time left in your benefit period.
Suppose you qualify for Medicaid due to a low income and limited resources. In that case, you will most likely receive coverage for nursing home care. These programs and their benefits vary from state to state. Nursing home stays can be expensive. Many people can spend down their income by paying for nursing home care, so they end up qualifying for Medicaid and can receive that coverage.
If you have long-term care insurance, your policy will help you pay for the type of custodial care that Medicare does not cover. Your insurance may also cover adult day care, assisted living, home health care, and more.
When you need nursing home care, you need to make a plan to pay for it. If you need coverage in addition to your health insurance, Magellan Healthcare can help you prepare for these costs. Contact our team to learn more about your options.
