Are Nursing Homes Covered By Medicare?
How much does medicare pay for a nursing home stay?
Medicare pays for skilled nursing home care based on a set rate that is adjusted annually. The base rate is adjusted up or down depending on the minimum patient payment and the cost-of-living adjustment.
Medicare pays for room and board based on set rates that are also adjusted annually. The rates are based on a patient's diagnosis, the kind of room, the location of the facility, and the level of care required.
Medicare does not pay for custodial care.
How do you find a skilled nursing facility to accept you?
When you are admitted to a nursing home, Medicare requires the facility to give you written notice of your rights. This notice should include the amount of time you have to decide whether to stay in the facility or not, as well as the Medicare payment information.
If you are admitted to a facility that is not enrolled in the Medicare program, Medicare will not pay for services until the facility is enrolled.
If you are admitted to a facility that does not accept Medicare, you should consider the following:
What are the costs of staying in the facility?
If you are able to pay for the cost of the nursing home care and any home health care – without going over your assets – you may want to consider a private-pay arrangement.
What types of services are available in the facility?
If you have health problems now or in the future, you should find out what services are available.
Will the facility be able to take care of you if you experience a stroke or a heart attack?
If you have dementia or Alzheimer's disease, will the staff know how to care for you?
Also, ask about the availability of on-site medical specialists.
If you have a choice among several facilities, you should consider a facility that has the staff and services you will need.
Will the facility provide transportation?
The facility should not only provide you with transportation to medical appointments, but also to family and friends.
You should also have access to public transportation.
Is the facility close to your family and friends?
You should be able to see your family and friends.
If you are in a nursing home, you can stay in touch with them by telephone, visits, and correspondence.
Having access to public transportation can help you and your family and friends stay in touch.
How do you enroll in a nursing home?
If you are thinking about going into a nursing home, you should ask the facility about its enrollment status and Medicare certification number. If the facility is enrolled in Medicare, it should give you a Medicare enrollment application. If you are admitted to the facility before the application is approved, the facility can bill for services until the application is approved.
If the facility is not enrolled in Medicare, you should make sure that you get an estimate of the costs of staying in the facility so you can decide if you can afford it. You can also ask the facility to give you information about how many of its residents are enrolled in Medicare and how much it will receive for services. You should then compare these figures to the cost of similar nursing home services in the community.
If you decide to stay in the facility, keep a copy of your Medicare application. If the home does not enroll or if it loses its Medicare certification, you should notify the local office that approves Medicare applications.
How do you contact the local office that approves Medicare applications?
The local office that approves Medicare applications is called the carrier. The carrier's address will be on the Medicare application. If you do not have the application, you can call 1-800-MEDICARE (1-877-690-1012) and ask for the carrier's address. This number can also give you the address of the facility.
What if you move to a new nursing home?
If you move to a different nursing home, Medicare will approve your new application as long as you were in the original nursing home for at least 30 days before the move. If you are admitted to the new facility before the Medicare application is approved, the facility can bill for services until the application is approved.
Medicare will also approve your nursing home application as long as you were in the original facility for at least 30 days before you moved. If you moved to a different nursing home, the new facility can bill for services until Medicare approves your new application.
What if you are in a skilled nursing facility for rehabilitation?
If you are in a skilled nursing facility for rehabilitation, Medicare will pay for your stay for up to 20 days. This is called the "initial hospital stay." If you need to stay in the facility after the initial hospital stay, Medicare will pay for rehabilitation services if they are needed.
Medicare will not pay for any nursing home services unless you are admitted to the nursing home for at least 30 days. If you are admitted to a facility before the 30-day period, the facility can bill Medicare for services provided until the 30-day period ends.
Do you get a choice of nursing homes?
Yes. You have a choice of nursing homes that are available and ready to accept you. You should look for a nursing home that has the services you need.
Where do you apply for Medicare?
You can apply for Medicare online at www.socialsecurity.gov/applyfordisabilitybenefits.
You can also apply for Medicare by calling 1-800-MEDICARE (1-877-690-1012) seven days a week between 7 a.m. and 7 p.m. local time or 24 hours a day. TTY users may call 1-877-690-1012.
If you are deaf or hard of hearing, you can call your local Social Security office. If you do not live in the United States, you can write to your local Social Security office or call Social Security's toll-free number for an interpreter.
What if you need help applying for Medicare?
If you need help