Nursing Homes – Medicare

There are several ways to pay for nursing home facility care. These include Medicare, Medicaid, long-term care insurance policies, veterans benefits, and private funding. Initially, many nursing home facilities are covered by Medicare, after which your options are long-term care insurance policies private payment or a combination of all. You should carefully read the description of all available reimbursements.
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  1. Medicare

    What can you expect for Medicare coverage?

    Conditions and Limitations

    If you’re using Medicare as your primary funding source, you should use that criteria when searching the OurParents Directory. This will ensure that you review only nursing home that are Medicare certified.

    • The first 20 days are covered in any Medicare approved skilled nursing facility.
    • For the days 21 through 100 Medicare will pay all covered services. The exception to this is a coinsurance that is adjustable annually in 2008 was $128.
    • Doctors’ visits
    • Nursing care
    • Semiprivate room rates
    • All meals (including special diets)
    • Physical, occupational and speech therapies
    • Lab and X-ray services
    • Prosthetic devices
    • Prescription drugs
    • Some medical supplies and equipment
    • Medicare has strict coverage limitations for skilled nursing facilities.
    • Not including the day of discharge, the beneficiary must be in the hospital for 3 continuous days
    • An individual must be admitted to the nursing facility within 30 days of their hospital discharge.
    • Treatment must be similar nature to that which was treated at the hospital.
    • Daily nursing or rehabilitation services are required.
    • There must be a determination that only inpatient services will be sufficient.
    • In addition to a doctor, specifying daily nursing services. They must also recertify at intervals of 5 days and 14 days after admission. In addition to that the doctor must recertify the need for daily nursing services every 30 days thereafter.
    • In addition to Doctor recertification of the need for services. Medicare will also have to review and approve the need for nursing services.
    • Lastly, they must be in nursing care for 100 days or less, and Medicare will also have to approve the length of stay. A 100 day stay is not automatically granted under the Medicare system.
  2. Managed-care

    What Is Covered?

    While typically excluding the prior hospital stay requirement,  managed-care typically covers all the same items that Medicare does. Typically there is a copayment charge, that is half of the costs during the 21 through 100 day stay.

    Conditions and Limitations

    Residents need to receive authorization from their insurance company, and the facility must be Medicare certified.

  3. Medicaid

    Participants using the Medicaid service must pay a portion of their nursing care costs with any Social Security benefits they receive

    What Is Covered?

    In most cases, an individual would need assistance with at least two activities and Medicaid would cover all the costs of nursing and medical equipment that a doctor may deem necessary.

    In addition, Medicaid will cover the holding of a bed for a for a select amount of time usually one to two-week period if a resident is requiring temporary hospital care.

    Also to allow visits with family or friends, and absence of 18 days per year is covered.

  4. Long Term Care Insurance (LTCI)

    What Is Covered?

    LTCI usually only cover facility care, but is dependent on individual policies. If you have LTCI, you should consult your policy or your insurance agent.

    An overview of which facilities are covered by Medicare/Medicaid

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