Though they may seem similar, skilled nursing facilities and nursing homes differ in the care they provide to patients.
A skilled nursing facility is an in-patient rehabilitation and treatment center where patients may go for physical, occupational, or speech therapy after an injury or illness after a hospital stay. Typically, patients may stay at the facility for one to two weeks, sometimes longer.
Nursing homes, on the other hand, are more focused on helping someone with activities of daily living (ADLs) such as bathing, dressing, and eating, also known as “custodial care”. Nursing homes and assisted living facilities provide assistance with ADLs, but differ in the level of care provided. Those in nursing homes may require 24 hour medical supervision, while those in assisted living are mostly independent but may require assistance with ADLs.
So what can patients expect Medicare to cover when it comes to these services?
What Does Medicare Cover?
For Medicare beneficiaries, Medicare provides 100 percent coverage for skilled nursing services for the first 20 days in a facility, and then all but $200 per day from days 21 to 100. Beyond 100 days, the beneficiary is responsible for all charges.
To qualify to for skilled nursing services, Medicare beneficiaries must:
- Be hospitalized with the status of “inpatient” for at least three days; if one is hospitalized with the status of “under observation” for three days, this does not qualify the beneficiary for skilled nursing care
- Enter a Medicare-approved skilled nursing facility within 30 days after leaving the hospital
Medicare does not, however, cover assistance with ADLs, and therefore will not cover nursing home or assisted living stays, as these could be covered under long-term care insurance. Long-term care insurance is less expensive and easier to obtain before 70 years old as this requires a form of medical underwriting. Medicare, will, however, provide medical care for nursing home and assisted living residents.
If you have questions about skilled nursing facilities or nursing homes and what your plan does or does not cover, reach out to ARC representative today. We are happy to walk through your plan with you or review your options so that you are covered when it comes to needing these facilities.