Medicaid and Medicare Nursing Home Coverage

Aging brings about concerns over long-term care for many individuals and loved ones, particularly if there are no options to remain at home. Some people have no one available to provide care for them in their own home or have needs that are not met at home. This often brings about decisions regarding nursing home care and how to pay for it.

Learn whether Medicare or Medicaid pays for nursing home care.

Does Medicare Cover Nursing Homes?

Nursing home care is often quite expensive for many nursing home residents or prospective residents. A common misconception is that seniors likely have little to worry about because they have Medicare.

Medicare pays for a variety of health care costs. However, nursing home custodial care by itself does not fit definitions or descriptions of health care. This sounds confusing for some individuals, who usually start out their nursing home residency paying out-of-pocket.

Medicare Part A covers your inpatient hospital stay, hospice, home health services, short-term skilled nursing facility stay with certain restrictions.

Medicare pays for skilled nursing facility care if you spent at least three days as an in-patient at a hospital. Some individuals that receive skilled nursing facility care at a Medicare-approved facility find their status changed to needing full-time nursing home care.

Although status changes at a skilled nursing facility sometimes occur, Medicare does not pay permanent residency costs at the facility. Your original Medicare does not pay for the custodial care received at a nursing home, even if your doctor determines that you now need nursing home care while you are already at a facility as a skilled nursing care patient.

What Are My Alternative Options To Pay For Nursing Homes?

Although Medicare does not cover residency or custodial care services, meaning assistance with activities of daily living (ADLs) such as needing assistance bathing, toiletry, assistance with meals, Medicare does still provide the same benefits that it provides if you still lived at home. If you are a nursing home resident and need to go to the hospital, your Part A Medicare benefits still cover its share of the costs.

Your Part B Medicare still pays its share of doctor visits and other outpatient visits, preventive health screenings, and medically necessary services.

If you have Part D prescription drug coverage, your prescription coverage continues once you move into a nursing home. Medicare indicates that nursing home residents receive their covered prescription medications from a long-term care pharmacy that works with your specific plan.

If you have a Medicare Advantage Plan or Medicare Supplement Plan, these plans normally do not cover residency and custodial care at a nursing home. Check with your plan provider to see what your benefits are or for benefits information for your loved one.

Paying for nursing home residency typically begins by self-pay. As resources begin to deplete, individuals and family members often look towards other sources for payment of nursing home care. Many nursing home residents become eligible for Medicaid after depleting resources.

Does Medicaid Cover Nursing Homes?

Medicaid is a source for many people who have no means of paying for their long-term care at a nursing home. The U.S. Department of Health & Human Services, Long Term Care site reveals that “Unlike Medicare,” Medicaid does cover costs of custodial care when you are in a nursing home.

You still have to meet all eligibility requirements for Medicaid. The program gives states considerable options in administering Medicaid in their state. This means you have to meet both federal and individual state guidelines for Medicaid eligibility before Medicaid begins paying costs related to nursing home care.

Becoming eligible for Medicaid does not automatically mean you become eligible for nursing home coverage through Medicaid. Meeting long-term care requirements in your state means that the state looks at your long-term care needs and conducts assessments to make sure you meet requirements for long-term care payment from Medicaid.

There are potentially fewer options regarding choice of nursing homes when Medicaid pays for your nursing home care. All nursing homes do not accept Medicaid. Nursing homes that do accept Medicaid are required to have and maintain licensure and certification as a Medicaid Nursing Facility.

It is important to note that in many cases if you are already at a facility for skilled nursing services, there is a possibility that you or your family member will not have to move to another nursing home once status changes or upon receiving notice of eligibility for Medicaid. This is because many facilities providing skilled nursing care also offer nursing home care.

Even if you or your loved one did not meet income guidelines to qualify in the past, there is the chance that you meet income qualifications for nursing home coverage. Some states have higher income guidelines for nursing home residents.

Check with your specific state to find out about Medicaid income guidelines and other regulations regarding Medicaid nursing home eligibility.

Where Can I Find Medicare And Medicaid Nursing Homes Near Me?

Medicare offers the nursing home Find and Compare Tool, which allows site visitors to find nursing homes that provide at least some coverage for Medicare and Medicaid recipients.

When you need senior living and senior care at a nursing home, you likely want to find and take advantage of available sources to locate an ideal nursing home for you or your loved one.

Ask individual nursing home staff about care and services provided, Medicare and Medicaid-covered care and other questions you have so you have a clear understanding of Medicare and Medicaid coverage for nursing homes.