Health

Does Medicare cover care homes?

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There may come a time in your life when you can no longer do everything you once could, including daily activities like bathing, cleaning, cooking, and more. When it becomes unsafe for you to live independently, it may be time to investigate care homes. Care homes offer 24-hour care by care assistants. Care homes are like assisted living facilities and nursing homes. However, the level of care required to care for their residents sets each type of facility apart.

What are care homes?

Care homes give their residents a ‘home-style” feel and provide 24-hour assistance. Typically, the care focuses on degenerative health conditions and reduced mobility, making daily activities harder to perform. Staff is available around the clock, but medical nurses are generally off-site.

Similar to care homes are assisted living facilities. These facilities may be a great fit for those who cannot live alone safely but do not necessarily need medical attention around the clock.

However, care homes are not to be confused with nursing homes. Staff is also available 24-hours a day, but skilled nurses are there to provide care for medical conditions. The level of care performed in a nursing home is higher than the care performed in a care home.

Nursing homes can include supervision, rehabilitation, and custodial care. Doctors often make rounds to speak with the residents on their needs. Residents with lower cognitive abilities may benefit from a nursing home, depending on the level of care they need.

Assisted living facilities and care homes can offer more freedom to their residents than nursing homes can.

What doesn’t Medicare cover?

Medicare does not cover custodial care if custodial care is the only care a beneficiary needs. Medicare would also not cover long-term care, including staying in a nursing home, care home, or assisted living facility.

What does Medicare cover?

Medicare has two parts: Part A and Part B. Part A is the inpatient hospital coverage for Medicare beneficiaries, and Part B is the outpatient medical coverage. During a stay in a nursing home, care home, or assisted living facility, Medicare Part A and B would cover the medical services performed if they are medically necessary.

Skilled nursing facilities

Skilled nursing facilities (SNF) are covered under Medicare Part A. These facilities offer short-term care, whereas care homes, assisted living facilities, and nursing homes offer long-term care. However, you need to meet specific criteria for Medicare Part A to pay its share of the cost. You need to be admitted into a SNF after spending three days in the hospital. The SNF also needs to be Medicare certified.

Medicare costs

Both Part A and Part B have deductibles that need to be met before Medicare picks up a portion of the costs of approved services. The Part A deductible is $1,484 per benefit period in 2021, and Medicare will only cover 100 days in a skilled nursing facility. After day 20, you would be responsible for a copay each day.

The Part B deductible is $203 in 2021, and once the deductible is met, then Medicare will pay 80% of approved Part B services. Suppose a beneficiary has medical services performed while in a care home, nursing home, or assisted living facility. In that case, the beneficiary must meet the deductible and expect to pay the 20% coinsurance.

A Medigap plan or Medicare Advantage plan will change the cost-sharing for the beneficiary.

Alternative options

For the costs that Medicare does not cover, such as the cost of long-term care and room and board in care homes and nursing facilities, a beneficiary can resort to alternatives. They can purchase a long-term care policy, use personal savings, or qualify for Medicaid. Some long-term care insurance policies can cover a range of care services or only cover nursing home care.

Conclusion

Original Medicare consists of hospital and medical coverage for beneficiaries. Long-term care is not included in Medicare’s coverage; therefore, care homes are not covered by Medicare. Short-term care in SNF and medical care performed in nursing homes and care homes can be covered by Original Medicare if deemed medically necessary.

Hume Greyson
the authorHume Greyson

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