Medicare Coverage For Home Care and Skilled Nursing Care

One of the biggest myths about Medicare is that itstays. If a patient meets the requirements to qualify
pays for long-term care. It doesn't. Medicare coversfor home care (see "How does someone qualify for
only limited periods of inpatient care in a skilledMedicare coverage of at-home care?" below),
nursing facility, and skilled nursing care and therapy atMedicare can cover skilled nursing care and physical
home, under strict guidelines. Still, Medicare's coverageand speech therapy as needed while the patient
of these services can be vital if the person you'rerecovers from an illness, condition, or injury. Medicare
caring for has just been hospitalized or has otherwisealso covers needed medical supplies and
suffered a serious medical event. Medicare can payequipment.Medicare doesn't generally cover
for costly short-term, intensive rehabilitation, which innonmedical at-home care and assistance, including
turn can give you a chance to arrange formeals and housekeeping. However, if a patient is
longer-term care if it's needed.Medicare coverage ofgetting Medicare coverage for skilled nursing or
inpatient care in a skilled nursing facility is a standardtherapy at home, Medicare generallys pays for limited
part of Medicare Part A. Someone already enrolled invisits by an aide from a home care agency to help
Part A doesn't have to do any special paperwork tohim or her with personal care. If Medicare covers
receive nursing-facility coverage.Skilled care at homeskilled care for the patient, it can also cover the
can be covered by either Medicare Part A orservices of an occupational therapist to help him or
Medicare Part B, under slightly different rules. Personsher relearn how to accomplish daily personal care and
enrolled in either Part A or Part B can receivehousehold tasks safely.
coverage for skilled home care without any additionalFor Medicare Part A or Part B to cover a patient's
Medicare enrollment.at-home care, several conditions have to be met:
"Nursing home" or "nursing facility" can refer to- Need for part-time skilled care: The patient must
different levels of inpatient care in different types ofhave a medical need for, and his or her doctor must
places, including rest homes, nursing homes,prescribe, skilled nursing care or rehabilitative physical
board-and-care homes, assisted-living facilities,or speech therapy. The care must be needed
congregate living homes, and sheltered care homes.part-time only, to help recover from a specific illness,
All of these provide what is called custodial care,injury, or acute condition. If, instead, the patient
which is long-term residence and nonmedicalneeds care because of a long-term condition or
assistance with the activities of daily living -- such asgeneral frailty, Medicare will not cover it. Nor will
bathing, eating, walking, and dressing -- for peopleMedicare cover full-time or daily care.
who don't have acute medical conditions but who are- Confinement to home: Medicare covers at-home
no longer able to care for themselves completely.care only if and for as long as the patient is "confined
This type of custodial long-term care is not coveredto home." This means that he or she is unable to
by Medicare.At the other end of the spectrum is aleave home without difficulty and with the assistance
much higher level of inpatient medical care, referredof another person or a medical device such as a
to as skilled nursing or rehabilitation care. Underwheelchair. However, it doesn't necessarily mean
certain circumstances, Medicare Part A covers thisbedridden.
skilled care for a limited time while a patient is- Recovery period: At-home care is covered only
recovering from a serious illness, condition, or injury.while the patient is actively recovering, which means
This care is usually provided in the nursing-facility wingwhile his or her condition is improving. Once a
of a hospital, in a separate skilled nursing facility, or inpatient's condition has stabilized, as determined by his
the skilled nursing part of a "multilevel" nursing oror her physician, the home care agency, and
rehabilitation facility.Medicare, coverage ends.
In order for someone to receive Medicare Part A- Medicare-approved agency: Medicare only covers
coverage for inpatient nursing-facility care, a numberhome care provided by a Medicare-certified home
of different conditions have to be met:healthcare agency. Unfortunately, this leaves out
- Prior hospital stay: A patient's stay in a nursing orregistry nurses, private therapists, and independent
rehabilitation facility has to begin within 30 days of ancaregivers.
inpatient hospital stay of at least three days.If a patient qualifies for coverage of at-home care,
- Need for daily skilled nursing or rehabilitation:Medicare pays the full amount of the home care
Medicare covers an inpatient nursing-facility stay onlyagency's charges, except for the rental cost of
if the person needs, and his or her physiciandurable medical equipment such as a wheelchair or
prescribes, daily skilled nursing care or physicalhospital bed (for which Medicare pays 80 percent).
rehabilitation. For someone who needs skilled care butSometimes, a patient's medigap insurance policy will
doesn't need it every day, Medicare will not cover anpick up this extra 20 percent; otherwise, patients
inpatient stay; instead, Medicare might cover homehave to pay for it personally. The home care agency
care.is not allowed to bill patients for any amount above
- Medicare-approved facility: For Medicare to coverthe Medicare-approved charges.Medicare doesn't put
inpatient skilled nursing or rehabilitation care, the careany specific limit on the number of home care visits it
must be received in a facility that Medicare haswill cover, nor on the total number of days patients
certified for that purpose.can be served by the home healthcare agency. But
- Improving condition: Medicare covers inpatient skilledcoverage will continue only as long as they meet all
nursing care only as long as the patient's condition isof the qualifying conditions for coverage. A patient's
improving. Once Medicare, the patient's doctor, andcondition and needs are regularly evaluated by the
the facility have determined that his or her conditionagency and by Medicare itself to determine how long
has stabilized, Medicare will no longer cover inpatientthe agency's care is medically needed and thus how
care.long Medicare will keep paying.
If, and as long as, a patient meets the qualifyingIf the person you're caring for is in the hospital and
conditions described above, Medicare will pay a limitedyou're looking for answers about follow-up
amount for inpatient nursing-facility care.For the firstnursing-facility or home care, contact the hospital's
20 days in the facility, Medicare pays all covereddischarge planner, who arranges both of these types
charges -- excluding only items like a telephone orof care, or the hospital ombudsman, who is trained in
television or a private room if not medicallyMedicare issues and helps patients understand
necessary.For days 21 to 100 in a nursing facilitythem.Even if he or she isn't currently in the hospital,
during any one benefit period, Medicare no longeryou can get information about nursing-facility and
pays any of the cost.home care coverage directly from Medicare's website
If a patient needs skilled nursing or rehabilitation careor by calling (800) 633-4227. If he or she has been
at home, either Medicare Part A (following a minimumreferred to a particular nursing facility or home care
three-day hospital stay) or Part B (no hospital-stayagency, the intake administrator for that service can
requirement) can cover it. The care may be providedalso help with Medicare-related questions or problems.
in the patient's home or anywhere else he or she