A nursing home can be defined as a Long Term Care Facility or a Skilled Nursing Facility. These types of round the clock care are covered differently and have completely different expenses, that can be hard be hard to gauge if you don’t know how they are covered. The biggest question is: does Medicare cover either one of them?
Does Medicare Cover Nursing Homes?
We have to break this down into two categories:
Does Medicare cover Skilled Nursing Facilities?
Yes, Medicare offers coverage for care in a Skilled Nursing Facility (SNF) for a limited amount of time AND if you have a 3 day in-patient qualifying hospital stay. This is what you’ll pay for days in a SNF.
- Part A Deductible: $1,364
- Days 1-20: $0
- Days 21-100: $167.50 per day
Does Medicare cover Long Term Care Facilities?
No, Medicare does not cover care in a Long Term Care Facility. Certain companies offer insurance for this type of care, but know that it can be rather inexpensive, so it’s better to enroll in a plan the younger you are.
Does Medigap Cover Nursing Homes?
Medigap plans can cover your Skilled Nursing Facility (SNF) coinsurance and hospital deductible, as long as you meet the 3-day qualifying hospital stay; however, they do NOT cover Long Term Care. This is what is covered with Medigap policies:
- All but one Medigap plan covers all or part of your Part A Deductible: $1,364
- All but two Medigap plans cover all or part of your SNF days 21-100 coinsurance: $167.50 per day
If you have a Medigap plan that covers both your deductible and coinsurance you should not pay anything out of pocket for these services.
Does Medicare Advantage Cover Nursing Homes?
Medicare Advantage plans partially cover Skilled Nursing facility care but leave you with a daily coinsurance, and, possibly, a hospital deductible. Good news with Medicare Advantage is some plans don’t require a 3-day inpatient qualifying stay. Medicare Advantage does not cover Long Term Care.
Remember Medicare Advantage plans are not standardized, so you will have to research all plans to learn what your SNF coinsurance and deductible would be.
For further questions please call to speak to a Senior65 agent at 800-930-7956.