Will Medicare Pay For Skilled Nursing Homes? And What if it Doesn’t?

Medicare is confusing. Between the different facets of Medicare to sifting through all the paperwork, it’s difficult to determine what Medicare covers as far as assisted living costs or expenses related to skilled nursing homes.

The answer also carries with it a number of variables, but in a nutshell:

Medicare will pay nothing toward assisted living costs but will pay something for the first 100 days of skilled nursing care.

Because there are limits on what Medicare will and won’t pay for these services, many people must look toward alternative ways of funding them. We’ll break these down and look at them one by one.

As always, if you need additional clarification as to what Medicare will and will not pay for, check with your Medicare representative or speak with one of our staff members who can help you determine how to best manage assisted living costs.

Does Medicare Help with Assisted Living Cost?

Medicare will not pay for any kind of assisted living.  Medicare will also not pay for room and board costs, nor will it provide payment for personal care assistance, such as help with bathing or dressing.

However, it will pay for any medical costs that might be experienced while in assisted living.

How Do You Pay for Assisted Living?

Just because Medicare doesn’t pay for the assisted living cost doesn’t mean that the benefits of this type of lifestyle are out of reach. The following are some useful options you may wish to consider to help finance either your move or the move of someone you love to assisted living.

However, before you take any action, you should speak with your financial advisor to examine the important details that can have a dramatic impact on your income.

  • Sell a home

Typically, if you’re searching for assisted living for yourself, you don’t plan on living at your home anymore, so selling it may be a good option.

  • Check into veteran’s benefits

If you’re a veteran, you may want to check into benefits through the Veterans Administration, which will sometimes pay for care, particularly for wounded or disabled veterans.

  • Consider a bridge loan

If you need immediate access to assisted living, but your home hasn’t sold or you’re still selling your assets, you may qualify for a bridge loan that can be repaid once your home or assets have been sold. However, bridge loans can be risky, so be sure to seek professional financial advice before going this route.

  • Medicaid

Depending upon your income, you or your loved one may qualify for Medicaid, which will cover a portion of assisted living costs.

What About Skilled Nursing Homes?

This answer is a bit different, and as always, it’s important to go into detail, so we recommend you speak with your Medicare representative.

However, under original Medicare, if you need skilled nursing care, it would pay completely for days 1-20 for each benefit period. However, after day 20 and up until day 100,  you will need to pay a $176 coinsurance per day. After day 100, you are responsible for all costs.

What About Other Services?

Sometimes your doctor or other members of your health care team may recommend certain services or even devices that you need. This may or may not be covered by Medicare, so it’s important that you do your research.

However, if your doctor prescribes treatments that are medically necessary–such as intermittent skilled nursing care or physical therapy –Medicare is likely to pay for it provided it meets certain criteria.

The important aspect to remember is that as long as these services are medically necessary to your recovery and treatment, and they are reordered by a doctor every 60 days, Medicare will continue paying a portion of it.

In addition, Medicare often pays 80 percent toward medical supplies such as wheelchairs, oxygen and walkers, if the items have been pre-approved.

What About Medicaid?

Some who are looking into assisted living costs or who are seeking to finance moving to a skilled nursing home can qualify for Medicaid.

How Can I Get Medicaid?

In North Carolina, it helps to check out the eligibility requirements at the North Carolina Department of Health and Human Services.

In general, to qualify for Medicaid, you must meet some of the following criteria:

  • Must be over 65 years old
  • Need long-term care
  • Be disabled
  • Meet income requirements
  • Be a U.S. citizen and a resident of North Carolina
  • Have a social security number

Do You Need Additional Information or Resources?

We understand that this information is just a tiny facet of the many rules and regulations of Medicare and Medicaid. For more information, you should speak to your representative to be sure you’ve got all the facts.

Need additional resources? We’ve compiled some of them for your convenience.

You can go to the government’s Medicare page.

Call 1-800-Medicare (1-800-633-4227) for specific billing and coverage questions

Contact the State Health Insurance Assistance Program (SHIP) if you need personalized information and assistance.

We Can Help You Navigate the Confusing World of Medicare and Medicaid

At East Carolina Rehab and Wellness, we are dedicated to helping you or your loved one by providing compassionate care and treating them as if they were our own grandmother or grandfather.

But we realize that stellar care is just one part of the picture.

We’ll work with you to help navigate the confusing waters of Medicare and Medicaid, providing clear information about costs so you won’t have to face any surprises. That’s what peace of mind is all about.

Schedule a tour to discover what sets us apart from other assisted living and skilled nursing facilities.