Medicare Part D is prescription drug coverage. Since benefits vary by plan, be sure to contact the specific Medicare Advantage plan you’re interested in for more information. Medicare Advantage plans could cover nursing homes, and some may only cover them when the nursing homes have a contract with the Medicare Advantage plan. These plans must offer at least the same amount of coverage as Original Medicare, Part A and Part B, but some can offer additional benefits beyond that coverage. Medicare Advantage ( Medicare Part C) plans: Medicare Advantage plans are offered through Medicare-contracted private insurance companies.Medicare Supplement insurance: Some Medigap plans will help pay for Medicare coinsurance associated with care in a skilled nursing facility.Other Medicare coverage options could potentially increase your coverage when it comes to nursing homes. Getting more coverage for nursing-home care The skilled nursing facility must be Medicare-certified for Medicare to cover the services.The skilled nursing services of the nursing home must be considered reasonable and necessary by Medicare.The skilled care that the nursing home provides and that you needs must have been part of the treatment during the qualifying three-day hospital stay or it must be to treat a condition that developed while you were being treated in the hospital or skilled nursing facility A doctor must determine that the skilled services are medically necessary, needed on a daily basis, and cannot be provided outside a skilled nursing facility.If you’re beginning a new Medicare benefit period of 100 days of skilled nursing facility coverage, then you must repeat the three-day qualifying hospital stay to meet the requirements for Medicare Part A skilled nursing home benefit. Keep in mind any time you spend in the hospital under observation services (even if you stay overnight) doesn’t count towards your three-day qualifying inpatient stay you must be formally admitted to the hospital as an inpatient. The qualifying inpatient hospital stay begins the first day you’re admitted to the hospital but does not include the day of discharge. Medicare beneficiaries must first be an inpatient in a hospital for three consecutive days before entering the skilled nursing home.You must have days left in your skilled nursing facility benefit for the benefit period (Medicare Part A includes 100 days of this benefits).Skilled nursing facility care is covered under Medicare Part A (hospital insurance) when the following conditions are met: What are the requirements for Medicare to cover skilled nursing care? If you leave the skilled nursing facility but get re-admitted within 30 days, you may not need another qualifying three-day inpatient stay. Your benefit period can also end once 60 consecutive days have passed since you were in a hospital or skilled nursing facility, or you haven’t received skilled nursing care in the facility for 60 consecutive days. If you use up these benefits or if you stop getting skilled nursing facility care for more than 30 days, your benefit period must end and you must have another three-day qualifying hospital stay to get coverage to get another 100 days of skilled nursing facility coverage. You can get up to 100 days of skilled nursing facility care in one benefit period. Your benefit period begins the day you start using your skilled nursing facility benefits under Medicare Part A. Non-essential services from nursing homes are not covered. Ambulance (if other transportation could endanger your health) to the nearest supplier of needed services not available at the skilled nursing home.Medications, medical supplies, and equipment used in the skilled nursing facility.
Physical therapy, occupational therapy, and speech-language pathology (covered if medically necessary to meet your health goals).Medicare Part A covers these services while you’re in a skilled nursing facility: What services does Medicare cover in a skilled nursing facility?
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Most nursing homes provide this type of care, also known as long-term care, and you’ll have to pay the full cost for this type of care.
Custodial care, or personal care, is not covered by Medicare if it’s the only type of care you need. Keep in mind that this is different from nursing home care that is considered custodial care, where a person is assisted with daily tasks such as dressing and bathing. Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period when the stay is medically necessary and follows a qualifying three-day inpatient hospital stay.
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