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Medicare Nursing Home Coverage in 2022: get a free quote

medicare nursing home coverage

In this article, we will discuss medicare nursing home coverage. Let’s dive into the article.

Health insurance policies over the years have made progress in the provision of quality healthcare around the world. With healthcare policies, individuals can have access to better quality healthcare. However, there are, of course, various factors involved in getting these healthcare insurance policies.

One of the major progress made in the healthcare sector is making a lot of special healthcare plans available for individuals that need assistance, especially plans like Medicare plans.

Medicare gives health insurance access to adult individuals that are 65 years old or older as well as qualified individuals with cases of disability. These sets of individuals have certain challenges that would normally prevent them from getting the most suitable health insurance plans normally.

Elders above the age of 65 are more susceptible to diseases because of old age; hence they’d require closer medical attention and treatments.

Also, most of the seniors in question would have retired from employment and would be living on pensions or whatever source of income that would not allow for much financial responsibility. And as a result, they might not be able to afford the healthcare services required for their health.

Individuals with disabilities also share this plight, of course. They are mostly incapable of catering to their healthcare financially, and when you consider the fact that these individuals need extra medical attention, the option of a special health insurance policy becomes a priority.

People generally need so many health services to ensure that they enjoy the maximum standard of healthcare. So, in this article, we will be talking about the nursing home coverage you can get with Medicare health insurance policies.

Individuals with health conditions, especially the elderly and disabled persons, generally need special medical attention with which they can receive the maximum specific health services that would help boost their health and facilitate an ace in recovery.

These specific services are mostly received in nursing homes or certain facilities that provide the maximum specificity as regards their health care.

Also called old people’s homes or assisted living facilities, a nursing home is a sophisticated environment with various facilities specifically for the welfare of elder individuals, people with disabilities, and every other individual with severe healthcare that requires special care.

Here, individuals receive healthcare services that are peculiar to their health condition, and services are rendered close to their health needs to ensure that a positive prognosis is achieved.

Based on a recent survey in 2022, over 1.3 million adults live in United States Nursing homes based on their health needs. These statistics mean that nursing facilities are a necessity in modern healthcare and should be covered by most health insurance policies.

However, Medicare does not cover nursing home services normally because these services are categorized as skilled or custodial services. And since Medicare mostly covers basic healthcare services that are classified as required and needed, they mostly do not offer health coverage for nursing facilities in the United States.

Notwithstanding, this is not the end; there are certain conditions where Medicare might agree to assist in financing specific aspects of your nursing home expenses.

You could also go for some specific plans that’d offer temporary coverage in some skilled nursing facility, especially when you need highly sophisticated special care.


medicare nursing home coverage


How Medicare Pays For Nursing Home Care

Most of the time, individuals in nursing facilities will have to pay for the services they receive themselves without help from Medicare unless they have private plans that offer nursing home insurance coverage.

However, sometimes Medicare might help individuals with limited resources if they meet up to certain requirements, even though not all Nursing facilities accept Medicare payments.

Disabled individuals under Medicare with Social Security benefits might qualify for Supplemental security income with which they can raise funds for their nursing facilities’ expenses.

Normally, Medicare does not cover nursing home care expenses; however, Medicare would give 100 days of nursing facility coverage for individuals in need of acute care. This is usually achieved under the Medicare Part A plan, where the individual receives nursing facility coverage in Skilled Nursing Facilities (SNF).

Here the individual’s illness is treated closely to ensure speedy recovery in alignment with the person’s prognosis. Individuals in these Skilled Nursing Facilities receive maximum healthcare services from trained professionals like physical therapists and registered nurses. Individuals are sent to these nursing facilities with the expectation that they’d recover on time.

It is, however, good to note that regardless of the method in which Medicare offers coverage for nurse facility services, Medicare would never offer health insurance coverage for services that are classified as non-medical or custodial.

For instance, individuals who have difficulties eating, bathing, dressing, etc would not receive nursing facility coverage from Medicare. They’d have to make the payment themselves.

This is because custodial care often requires a long-term stay in the nursing facility, plus those who provide such care are not usually healthcare professionals; hence Medicare would not be part of such coverage. Medicare focuses on health needs that are classified as “required.”


Cost Of Medicare Nursing Home Care 2022

Nursing home care is generally very expensive, although the expenses might reduce with health insurance intervention. Medicare, for instance, helps to improve the affordability of Nursing home coverage.

This coverage would also depend on the state, insurance company, and many other factors. As of 2022, the average cost for Medicare in the United States amounts to about $300 daily, which would be an average of $9,000 every month.

The amount has been on the increase exponentially but can be subsidized with Medicare plans. Medicare might cover as much as 70% of the entire expenses or more, depending on your Medicare package.

Also, whether you’re using an additional Medicare plan like Medigap or Medicare Advantage would determine how much you’d pay for nursing facilities.

It is also important that we note that specific health needs would also determine the type of Nursing Home care and hence expenses that would be incurred. Individuals should do proper research and choose the most suitable and cost-effective nursing home around them.


How much does Medicare pay for long-term nursing home care?

Most times, Medicare does not cover long-term nursing facility expenses. However, there might be very certain exceptions.

The long-term cost of nursing home care depends on various factors ranging from the nursing home you choose to the city the nursing facility is located. It also depends on factors like the inclusion of special services, as well as the services that you’d require in the nursing home.

Some nursing homes would charge additional expenses for memory care, speech therapy, physical therapy, and many other uncommon services. This means you might pay more for nursing home care depending on the services you demand.

Over the past few years, the cost of getting into a nursing home has risen dramatically, and based on statistics, these figures will keep rising if nothing is done about it. Individuals already spend about $9,000 monthly on nursing homes; in the next five years, the figure might rise to about $12,000.


Medicare Plans that may assist with nursing Home Expenses.

Although Medicare would generally not cover health services that are not regarded as medically necessary, there are several aspects of Nursing health facilities’ services that are very important to the prognosis of both the elderly and individuals with disabilities.

If Medicare approves this service to be worth it, the individual might receive conditional healthcare coverage under the following categories.

Medicare Part A:

The Medicare Part A plan is known widely for its coverage of medical expenses within the Medicare network. However, it can also extend to Special Nursing Facilities in times when Medicare has approved the funding of Nursing Facilities.

Although Medicare Part A would only offer short coverage, this coverage might even include medications and drug descriptions depending on the person’s plan.

Medicare Part B:

Usually, Medicare Part B mostly covers healthcare services outside the Medicare network. Hence, it doesn’t offer healthcare coverage for nursing facilities.

However, there are certain special cases where Medicare Part B plans would provide the funds for Nursing home services. Nevertheless, this is very rare and depends on specific health insurance companies.  

Medicare Part C:

Medicare Part C, also called the Medicare Advantage plan, is a government-sponsored private plan that offers coverage to additional health benefits that are not found in either of the Medicare Part A or Part B plans.

Usually, it is difficult to find Medicare Advantage plans that cover nursing home care. However, the coverage usually depends on the private insurance company. hence, you might be lucky to get a Medicare Advantage plan that covers nursing home care if you research properly.

Medicare Part D:

The Medicare Part D plan is an extra health insurance plan under Medicare that helps to provide additional coverage for healthcare prescriptions for drugs. This Medicare Part D plan offers drug prescription coverage upon request for individuals in nursing homes.

Medicare Supplement:

Also called Medigap plans, the Medicare Supplement does not offer health insurance coverage for long-term nursing home care. However, one can get coverage on nursing facilities out-of-pocket expenses like deductibles and copayments via Medigap coverage.


What Happens When Medicare Stops Paying For Nursing Home Care

Usually, Medicare offers skilled care in Nursing Facilities any time it offers coverage; this means individuals would receive very intentional care to help enhance their health.

Now, this coverage typically lasts for 100 days, after which the individual would have to seek coverage elsewhere. In conditions of severity, they might be exceptions whereby Medicare would extend the 100 days.

Nevertheless, this is very rare, and almost no one has benefited from such, mostly because the 100 days period is mostly enough.

To extend your period of coverage once Medicare stops paying for nursing home care after the 100 days timeframe, you can try several options like getting a Medicaid plan for coverage or seeking other types of Medicare plans other than the Original Medicare plans – Part A and Part B.

Also, depending on the severity of the case, the individual might become hospitalized if not, you’d have to pay yourself. You could do so by seeking an additional insurance plan or by seeking help from friends and family.


Frequently Asked Questions

  • Will Medicare pay for nursing home care?

Yes, with the right Medicare policy coverage and insurance protocol, you can get Medicare coverage to pay for your nursing home care.

If you can get access to a medical facility near you that accepts Medicare coverage for nursing home care, you might be eligible to get a suitable plan from whichever of the Medicare plans – typical or supplemental plans.

  • How much does Medicare pay for nursing home care?

The cost of Medicare nursing home care for Americans usually differs and varies slightly depending on the state or region. It would also depend on the size of the coverage.

Nursing home care with Medicare coverage for a shared room may cost an average of 7000 dollars to 8000 dollars a month; and up to about 900 dollars monthly- slightly higher for a private room.

In some states, the payment could shoot up to as much as 24,000 dollars for a month.

  • How long does Medicare pay for nursing home care?

Medicare covers the cost of nursing home care for an average of mostly 100 days. That’s especially for Original Medicare plans like Medicare Part A and Medicare Part B plans.

The average stay is usually about 22 days only. You may get wider coverage lengths in days from other Medicare types of plans.

After the 190 days of Medicare coverage for nursing home care, you should find other ways to cover the cost of your nursing home care without Medicare plans.

  • Does Medicare Part B Pay For Nursing Home Care?

Yes, the Medicare Part B plan is a form of the Original Medicare plan. So, with it, you can get coverage for nursing home care.

With a suitable Medicare Part B plan, Medicare would pay for your nursing home care costs. All you need to do is be eligible for such a Medicare plan and apply for it to get the maximum length of days for Medicare coverage with the Part B plan.

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