Learn the essential conditions for receiving Medicare nursing home benefits and how to navigate the process effectively

Los Angeles: Figuring out Medicare nursing home coverage can be a bit confusing, but it’s important to know the details. Medicare Part A helps cover care in a skilled nursing facility if it’s medically necessary. This includes things like wound care or physical therapy that need skilled professionals.
But here’s the catch: most nursing home care is considered custodial care, which Medicare usually doesn’t cover. Custodial care is all about daily activities like bathing or dressing, and it doesn’t need medical training.
So, what do you need for Medicare to cover nursing home care? First, you must have a qualifying hospital stay of at least three days. A doctor also needs to say that skilled nursing care is essential for your recovery. Plus, the care has to happen in a Medicare-certified facility and relate directly to the condition treated during your hospital stay.
If you’re on a Medicare Advantage Plan, the coverage can vary. Many plans require nursing homes to have contracts with them, so it’s smart to check your plan’s details and the facility’s quality ratings before making a decision.
Now, about paying for nursing home care: Medicare doesn’t usually cover long-term stays, but there are ways to manage costs. Medicaid can help with expenses for those with limited income and assets, and many nursing homes accept it. Long-term care insurance can also assist with costs, so check your policy for specifics.
Some life insurance policies even let you use them to cover long-term care costs, so it’s worth asking your provider about that. If you qualify for both Medicare and Medicaid, you might get extra help with medication and other expenses.
As healthcare advocate Mike Bonin says, “Understanding your benefits can save you significant stress and money in the long run.” While it might feel overwhelming, resources like state Medicaid offices and insurance providers can really help. Knowing your coverage and planning ahead can make a big difference when it comes to nursing home care.