What Will Insurance Cover in a Nursing Home?
Nursing home care can be expensive and insurance support is limited. Insurance coverage and network participation are two of the most important factors to consider when choosing a nursing home.
Medicare
The original Medicare plan does not cover long-term care in a nursing home, however it does cover limited, medically necessary, skilled nursing care provided in some nursing homes. Medicare may be applied for specific hospital care, physician services, and medical supplies.
Medicare may be applied for extended stays at a nursing home if the nursing home is a certified psychiatric hospital and the patient is receiving care for a psychiatric condition. In this situation, Medicare will provide financial support for the first 190 days that the patient receives care at the nursing home.
Some Medicare Advantage plans or other Medicare plans do cover care in a nursing home if they have a contract with that nursing home. It’s important to check with your insurance plan as well as with the provider to verify what insurance will and will not pay for during your stay.
Medicaid
Most people entering nursing homes begin by paying for their care out-of-pocket however Medicaid can be applied if the patient is or becomes eligible during their stay. Most nursing homes accept Medicaid payments however Medicaid programs vary from state to state and eligibility depends on income and personal resources. Call your state’s Medicaid office and verify coverage with a nursing home before making final care arrangements.
Long-Term Care Insurance
Some individuals get long-term care insurance to assist in paying for nursing home care. Long-term care insurance care insurance can be used for a wide variety of extended care including home care, adult day care, and care through an assisted living facility. When shopping for long-term care insurance, it’s important to consider what facilities and what services are covered by which plans.
Lastly, some health insurance policies will allow patients to use their life insurance to pay for long-term care. repisodic encourages all patients to consult with their insurance company or administrator for final determination of what nursing home care their policy covers.
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