Blog, Medicare

One of the biggest misconceptions about Medicare is that it provides long-term nursing home care in Alabama coverage. It doesn’t.

Medicare covers only limited periods of inpatient care, only in a skilled nursing or rehabilitation facility following a hospital stay, and only under strict guidelines. Still, Medicare nursing home care coverage in Alabama can be vital if the person you’re caring for has just been hospitalized. Medicare can pay for costly short-term, intensive rehabilitation, which in turn can give you a chance to arrange for longer-term care if it’s needed.

Medicare or Medicaid?

One of the reasons many people mistakenly believe that Medicare covers long-term custodial care is that it is easily confused with Medicaid, which is a separate program only available to people who have very low income and few assets other than their home. Unlike Medicare, Medicaid can cover long-term care, either in a nursing home or at home.

Who’s eligible for Medicare nursing home coverage?

Medicare nursing home coverage is a standard part of Medicare Part A. Anyone enrolled in Medicare Part A can receive Medicare nursing home coverage if they qualify for it. There’s no special paperwork needed to apply for Medicare nursing home coverage; the nursing home itself handles all the administration.

If the person you’re caring for is enrolled in a Medicare Part C Medicare Advantage plan, it too will cover nursing home care, at least to the same extent (described below) as Medicare Part A does, and perhaps with somewhat broader coverage. Contact the plan directly to find out the exact terms of its nursing home coverage.

What kind of nursing home care does Medicare cover?

The term nursing home can refer to different types of places, including rest homes, nursing homes, board-and-care homes, assisted-living facilities, congregate living homes, and sheltered care homes. All of these provide what’s called custodial care, which is long-term residence and non-medical assistance with the activities of daily living — such as bathing, eating, walking, and dressing — for people who don’t have acute medical conditions but who are no longer able to care for themselves completely. This type of custodial long-term care is not covered Medicare.

At the other end of the nursing home spectrum is high-level inpatient medical care, referred to as skilled nursing or rehabilitation care. Under certain circumstances, Medicare Part A covers this skilled care for a limited time while a patient is recovering from a serious illness, condition or injury. For Medicare to cover this care, it must be provided in the skilled nursing facility wing of a hospital, in a stand-alone skilled nursing or rehabilitation facility, or in the skilled nursing or rehabilitation unit within a “multilevel” facility.

How does someone qualify for nursing home coverage with Medicare?

For someone to receive nursing home coverage under Medicare, a number of different conditions have to be met:

• Prior hospital stays: A patient’s stay in a skilled nursing or rehabilitation facility must begin within 30 days of an inpatient hospital stay of at least three days (not including the day of discharge).
• Need for daily skilled nursing or rehabilitation: Medicare provides nursing home coverage only if the patient needs — and his or her physician prescribes — daily skilled nursing care or physical rehabilitation. For someone who needs skilled care but doesn’t need it every day, Medicare won’t cover nursing home care. However, in that situation Medicare might cover home care.
• Medicare-approved facility: For Medicare to cover inpatient skilled nursing or rehabilitation care, the care must be received in a facility that Medicare has certified for that purpose.
• Improving condition: Medicare covers nursing home care only if the patient’s condition is improving. Once Medicare, the patient’s doctor and the facility have determined that his or her condition has stabilized, Medicare will no longer cover inpatient nursing home care.

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