It should be noted that Medicare only pays for up to 100 days of care in a skilled nursing facility during each benefit period. And, after 20 days, the patients. Medicare covers up to 100 days of SNF care per benefit period. Learn what happens when your coverage runs out, how to qualify for a new benefit period, and alternative options for continuing care.
Medicare currently has a tiered payment system for specialized nursing home facilities. For days 1 to 20, the program will pay the full cost of covered services. This includes a semi-private room, meals, medications, medical supplies, dietary counseling and rehabilitation care. For days 21 to 100, you must pay a co-pay and Medicare will cover everything else.
The amount of the co-payment changes annually. After day 100, your Medicare coverage will no longer apply and you will be forced to pay the full cost of services. Because it's designed to supplement coverage, Medigap doesn't pay for assisted living or other types of long-term care. However, some (not all) Part C plans may cover certain non-medical services similar to those offered by assisted living centers, such as help with daily living activities, meal delivery, and transportation to and from medical appointments.
A number of states offer help to cover the costs of assisted living to eligible older adults who have limited financial resources (e.g., while Medicare doesn't usually cover long-term care in assisted living facilities, there are certain types of long-term care that it will help cover). Medicare generally doesn't cover long stays in skilled nursing facilities, such as nursing homes. Assisted living centers are for people who may need help with their daily activities, but don't require the level of care that nursing homes provide. Paying out of pocket for a nursing home can quickly drain your savings and can seriously affect financial planning for your loved one's needs should they arise in the future. Assisted living is an option for people who can usually take care of themselves, but who need help managing tasks such as household chores, meals and other household tasks.
While long-term care coverage in nursing homes is limited, Medicare provides other important benefits to nursing home residents. Assisted living communities are all unique, with different features and services that range from dining rooms and common social areas to libraries and movie theaters. Medicare Part A specialty care coverage in a Medicare-certified skilled nursing facility is limited to 100 days and only the first 20 days are fully covered by Medicare. Resources For Living is not available to members of Aetna Part D plans (by prescription only), dual-eligible special needs plans (D-SNP), special needs plans for chronic conditions (C-SNP), institutional plans for special needs (i-SNP), or Medicare supplement plans. The unfortunate reality is that Medicare will only pay for the expenses of a nursing home under very limited circumstances.
If you need help understanding your health insurance, contact the Virginia Insurance Counseling and Assistance Program (VICAP) to find an advisor near you.
