As Americans are living longer, older individuals are more in need of senior care then ever. For some, this means having someone visit the home once a day or a few times a week to assist with general care and light housekeeping, but for others, around-the-clock medical care is required. In these cases, a nursing home may be a good option, but the question of paying for nursing home care often looms large on the minds of seniors and their loved ones. Nursing home care can cost tens of thousands of dollars per year for basic care, but some nursing homes that provide intensive care can easily cost over $100,000 per year or more.
How Much Does Medicare Pay for Nursing Home Care?
For seniors and qualifying individuals with Medicare benefits, there’s some good news and some bad news. While Medicare benefits do help recipients with the cost of routine doctor visits, hospital bills and prescription drugs, the program is limited in its coverage of nursing home care. This is because nursing home care varies greatly in terms of scope and amenities. Under Medicare, recipients do not receive benefits for custodial care, but instead, only for required medical care.
In addition, you must have Medicare Part A coverage to receive care in a residential medical facility. The facility must qualify as a skilled nursing facility, meaning once again that traditional residential nursing homes are not covered. If you opt to reside in a nursing home that simply provides on-site medical staff and assistance with light housework, you likely will need to pay for the entire cost out of pocket. In order to qualify for coverage in a skilled nursing facility, the stay must be medically necessary and ordered by a doctor. The facility will also need to be a qualified Medicare provider that has been approved by the program.
The other challenging part of the equation is that Medicare only covers temporary care in a skilled nursing facility. If you have Original Medicare, you are fully covered for a stay up to 20 days. After the 20th day, you will be responsible for a co-insurance payment for each day at a rate of $176 per day. Once you have reached 100 days, the cost of care for each day after is your responsibility and Medicare provides no coverage.
Does Medicare Advantage Offer More Benefits?
A Medicare Advantage plan provides the same base benefits of Original Medicare, but some plans may offer additional discounts or assistance when paying for care in a nursing home or skilled nursing facility. You may also be able to receive custodial care at a discounted rate depending on your plan and provider. Because each situation is different, you will need to discuss the specifics of your situation with a plan provider in order to understand your costs and coverage limitations.
At-Home Care as an Alternative
Some Medicare recipients may also qualify for discounts on at-home care provided by a nursing service. These providers often allow seniors to stay in their own homes while still receiving routine monitoring and basic care from a nurse who visits on a schedule. These services, however, are typically only intended for individuals who are able to care for themselves independently and are not designed to assist with serious medical issues. Once again, Medicare generally does not provide coverage for these types of services, but being a Medicare recipient may allow you to take advantage of special rates. To learn more, you will need to speak with a provider of at-home care services.
Does Medicare Cover Custodial Care?(Opens in a new browser tab)
Does Medicare Cover Assisted Living? (Opens in a new browser tab)