Medicare will help pay for skilled nursing facility costs in only one situation.
You must be an inpatient in the hospital for at least 3 days and then go to the skilled nursing facility, generally within 30 days of leaving the hospital. Note: an observation stay in the hospital does not count as being an inpatient. See Page 40 of the Medicare & You Handbook and also article on inpatient vs outpatient.)
In only this situation will Medicare cover the first 20 days in a skilled nursing facility. Days 21-100 are covered under most Medicare Supplement plans. After day 100, all costs are the patient’s responsibility.
Often times a patient needs to go to a skilled nursing facility to receive physical therapy, occupational therapy, or other care. In this case, services provided must be related to the condition for which the patient was seen at the hospital. If you are not an inpatient for a minimum of 3 days you will be responsible for the full cost in the skilled nursing facility.
How about Home Health Care? Medicare will only cover towards home health care in the event you are homebound, and there must be a plan of care ordered by a physician. Medicare will only provide part-time care for physical therapy, speech-language pathology, or continued occupational therapy services. Medicare will not pay for 24 hour care at home or help performing activities of daily living (eating, dressing, bathing, toileting, or transferring).
Consider Some Facts:
- Average daily cost for a Skilled Nursing Facility = $227 per day *1
- Average length of stay for discharged residents of a Skilled Nursing Facility = 270 days *2
- Average daily cost for Home Health Care = $114 per day *1
Many people today would much rather receive the level of care they need at home. To help cover costs Medicare does not there are Short Term Care Insurance plans. These plans are similar to Long Term Care insurance plans, however Short Term Care plans cover for a shorter period of time and are also much more affordable. A Short Term Care plan will cover Skilled Nursing Facility costs, Home Health Care, Adult Day Care, and Hospice for up to one year.
You are able to receive benefits from a Short Term Care plan when you are simply unable to perform two or more activities of daily living or require supervision and direction due to a cognitive impairment. A Short Term Care plan will pay even if Medicare is also paying. A Short Term Care plan will pay immediately when care is needed, meaning you will not have a waiting period for benefits to start. Benefits from a Short Term Care plan are paid to you or someone on your behalf.
As with any form of insurance, the best time to purchase a Short Term Care plan is the day before you need it. Since we don’t know when we might need the benefits of a Short Term Care plan, it is best to start a plan early. There are health questions asked in order to qualify and Senior Savings Services can show you the plans and options available to you.
Below is a recent news video on observation status (sorry for the short ad before video plays):
The news article and video can also be seen here.
Here is another story:
Contact Senior Savings Services at 1-800-592-0819 if you have any questions or for an understanding of options available to protect you from Skilled Nursing Care expenses and/or Home Health Care expenses.