Planning for nursing home care can feel overwhelming, especially when you're trying to understand how Medicare fits into the picture. Whether you're planning for the future for yourself or navigating options for a loved one, you'll need to know what Medicare covers and, just as importantly, what it doesn't.
In this blog, we'll cover the specifics of Medicare coverage for nursing home care. From short-term coverage for skilled nursing to alternative payment options for long-term care, we'll help you prepare for the decisions ahead. Let's make sense of Medicare together so you can plan with confidence!
Understanding Medicare and Nursing Home Coverage
Although Medicare does provide coverage for care received in a skilled nursing facility (SNF) for certain qualifying situations, long-term nursing home care is not a covered benefit.
Does Medicare Pay for Long-Term Nursing Home Stays?
As noted above, Medicare does not cover the costs incurred from long-term care within a nursing home facility. Although nursing home residents may receive medical care that Medicare covers, they also receive housing and custodial care, which Medicare does not pay for. Custodial care is defined as non-medical care that includes activities of daily living (ADLs). This entails assistance with things such as hygiene (bathing, toileting), dressing, cooking and more.
Short-Term Nursing Home Care: What's Covered?
Medicare does provide coverage for care received in a nursing home or skilled nursing facility, but only for a limited time and under specific conditions. For instance, this may include care post hospital discharge, or after a qualifying surgery, such as a joint replacement, amputation or spine surgery. During this recovery period, Medicare helps cover costs for rehabilitation and ongoing medical monitoring.
Note: Medicare Part A provides coverage (at varying costs) for up to 100 days of care in a skilled nursing facility for each benefit period.
Find out more about the qualification guidelines and limitations for SNF care coverage.
Options for Paying for Nursing Home Care
According to a study from the Administration of Community Living (ACL), “someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years”' As a result, being prepared for the likelihood of transitioning into a nursing home and afford the expense of long-term care is increasingly important. Here are several ways these costs can be covered:
Personal Savings
One way to pay for long-term care is self-funding, but most people struggle to save enough, and the high costs of long-term care can quickly drain savings.
Long-Term Care Insurance
Long-term care insurance is similar to other types of insurance policies, where you pay a monthly premium over time. If you need to use it, you will receive coverage as described within the policy's benefits, which will help cover the costs of extended care services, including assisted living, nursing homes, or home-based care. It's important to note that LTC insurance typically does not cover all the costs associated with nursing home care.
Find Out More: Long-Term Care Insurance: Is It Worth the Investment?
Long-Term Care Annuity
A long-term care annuity combines an annuity with long-term care insurance benefits. It can be an ideal investment option as it can be used to help cover LTC costs while keeping annuity funds available if such care isn’t needed.
Get More Information: Long-Term Care Annuity: How Does it Work?
Home Health Care Subscriptions
Subscription-based programs, like home health care subscriptions, are another option that can help with care costs later in life. They’re a good alternative if you're unable to obtain traditional long-term care insurance due to medical or cost barriers, as they generally have less underwriting and flexible budget options.
There is a lot of information to review when it comes to understanding Medicare’s coverage for nursing home care and making a solid plan to pay for these expenses that are likely to occur later in life. At Twin City Underwriters, our team of agents specialize in insurance options for seniors and can help you assess whether options like a long-term care annuity or a home healthcare subscription are right for you. With our professional guidance, you make informed decisions to establish a plan that protects you financially and meets your needs or those of a loved one.
Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Attend an online Medicare webinar, in-person Medicare workshop, or schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!
Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, UCare, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.