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Will Medicare Cover Nursing Home Care?

Those eligible for Medicare may also require nursing home care. Nursing homes provide a broad range of services, but Medicare doesn’t cover all of them. However, there are coverage choices you can make so that you minimize the amount you spend for nursing home stays.

What Will Medicare Cover, and Why?

Medicare only covers certain facets of nursing home treatment. The amount of time required to stay in a facility also plays a role.

Hospice care is an example of what Medicare will cover. Medicare Part A is responsible for helping individuals cover hospice-related expenses. Hospice treatments are aimed at treating pain, with Medicare covering items such as:

  • Medications
  • Medical equipment
  • Grief counseling
  • Nursing and social services

Medicare covers this because these require a licensed medical professional. It only covers what’s medically necessary – not unskilled labor.

The severity of your condition and your length of stay influences whether Medicare will cover you. If your condition is severe enough for you to be admitted to a skilled nursing facility, Medicare Part A will assist you with covering those costs.

Is There a Medicare Plan for Individuals Who Live in Nursing Homes?

There is one plan under Medicare Advantage that is created for individuals living in nursing homes and other institutions. This is the Institutional Special Needs Plan (I-SNP).

I-SNPs have strict guidelines for eligibility, as these plans are limited to individuals who qualify for Medicare and have been proven to need at least 90 days in a nursing home or other facility. I-SNPs will help individuals save more on certain services during nursing home stays.

You can join an I-SNP during one of these times:

  • Initial Enrollment (three months before you turn 65 to three months after you turn 65)
  • Annual Election (October 15 – December 7)
  • Medicare Advantage Open Enrollment (January 1 – March 31; you can only switch from one Medicare Advantage plan to another, or switch from Medicare Advantage to Original Medicare)

What Doesn’t Medicare Cover?

Many services provided in nursing homes do not qualify as medically necessary treatments. These include assistance with such activities as:

  • Bathing
  • Grooming
  • Getting dressed
  • Moving from one area to another

These types of services are also known as custodial or long-term care. Since these are not technically medical services, you may need to join an insurance plan specifically for custodial care.

How Can I Save More?

Depending on the state you live in, you may qualify for Medicaid. Medicaid lets you get coverage for nursing home stays as well as the care you receive in them. You can have both Medicare and Medicaid to save the most on your treatments.

We Can Help!

There’s no better place in Hawaii to get Medicare coverage than Proinsurance Hawaii. We strive to get you the Medicare coverage you need, and make your dollar work for you when you need it. We’re here for you, and today is your opportunity. Call us today at 808-735-0106. You’re one step closer to getting the best plan for you.