Medicare Coverage and Long-Term and Skilled Nursing Care
Medicare beneficiaries who need assisted care due to an illness or injury may be surprised to find out what their Medicare actually covers.
“First, it is always important to review what nursing care services are covered under Medicare,” suggests Alan Weinstock, insurance broker at MedicareSupplementPlans.com. “Then if you have Medigap along with your original Medicare plan, find out what that will cover as well.”
Differences between Long-Term and Skilled Nursing Care
When considering Medicare coverage, Medicare beneficiaries might want to start by understanding the differences between long-term care and skilled nursing care.
According to Medicare, long-term care is actually a variety of services. The services include both medical and custodial care to people with a chronic illness or disability. Custodial care is non-skilled, personal care which provides help with daily activities such as bathing, dressing and eating. Long-term care can be provided at home, in the community, in assisted living or in nursing homes.
Skilled nursing care, on the other hand, is generally more short-term and focuses specifically on the type of care that involves the daily assistance of nursing or rehabilitation staff. It generally can be provided only at a skilled nursing facility. Skilled care is typically available for a short time after a hospitalization and involves services such as intravenous injections and physical therapy.
Medicare Coverage for Long-Term Care and Skilled Nursing Care
Generally, Medicare does not pay for long-term care, and custodial care alone won’t qualify you for Medicare coverage in a skilled nursing facility. Medicare pays only for a medically necessary skilled nursing facility or home health care. However, if you qualify for coverage based on your need for skilled nursing or rehabilitation, Medicare will cover all of your care needs in the facility.
Medicare pays for 100% of skilled nursing care for up to 20 days and 80% of the cost of another 80 days. Several of the Medigap plans available will cover the remaining 20% for those 80 days, meaning you can receive a total of 100 days of skilled nursing care with very little out of pocket cost.
The best Medigap plans also will pay an “at-home recovery benefit” of up to $40 visit up to a maximum benefit of $1,600 per year. This covers custodial care only on a short-term basis after an illness, injury or surgery.
Knowing in advance what nursing care services are available to you under original Medicare and your Medicare supplement insurance plan can help you plan wisely should you ever need to avail yourself of these services. That means knowing if Medicare with a supplemental Medigap policy or a Medicare Advantage Plan is right for you. Consider your options by getting the facts from the Center for Medicare and Medicaid Services or the experts at MedicareSupplementPlans.com.
Medigap insurance can give what the original Medicare Supplement cannot and this is a very effective advantage of the Medigap insurance California.
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