This information was gleaned from www.Medicare.gov. I hope it is helpful to you. For a complete booklet, click title: “Medicare Coverage of Skilled Nursing Facility Care.” (pdf)
Or call 1-800-Medicare (800-633-4227). TTY users should call 1-877-486-2048.
Consider Senior Care Options
You may have other long-term care options like community services, home care, or assisted living depending on your needs and resources. Before choosing a nursing home, see if one of these other choices might be better for you, or if they might help after a short nursing home stay.
Helping A Person Choose Senior Care Options
Helping another person choose a nursing home or make other long-term care choices can be difficult. Your support is important and can help your loved one adjust to getting new services or living in a new setting like a nursing home. Be sure to include the person you are helping when making decisions whenever possible. Always make decisions with their needs and preferences in mind.
Medicare Coverage for Nursing Homes
Paying for Nursing Home Care:
Medicare generally doesn’t cover long-term stays in a nursing home. Medicare does cover some skilled nursing and rehabilitative care after a hospital stay under the skilled nursing facility benefit.
Most people who need a long-term stay in a nursing home (that is, beyond 100 days) pay for their nursing home care (room and board) using the following:
- Their personal resources
- Long-term care insurance
- Medicaid, if they are eligible
For more information on paying for nursing home care, see pages 39–45 in the booklet “Medicare Coverage of Skilled Nursing Facility Care” (pdf) at www.Medicare.gov/library.
Your Medicare Benefits:
If you have Original Medicare or a Medicare health plan and are considering moving into a nursing home, you pay for room and board using the resources listed above. When you live in a nursing home, you can still use your Medicare coverage to pay for hospital care, doctor visits, and prescription drugs.
Medicare Coverage for Hospital Stays and Subsequent Skilled Nursing Care
If you have Original Medicare or a Medicare health plan:
- If you need short-term care in a Skilled Nursing Facility after a Medicare-covered inpatient hospital stay of 3 days or more, the hospital staff can help you find a Medicare-certified facility that gives the care you need. For more information on Medicare coverage of skilled nursing facility care, view the booklet “Medicare Coverage of Skilled Nursing Facility Care.” (pdf)
- If you think you are being asked to leave a hospital (discharged) too soon, you can ask for a review from your Quality Improvement Organization (QIO). The QIO is an independent reviewer who will give you a second opinion about whether you are ready to leave the hospital. Your hospital services will continue to be paid during the review (except for charges like your coinsurance and deductibles). Use the QIO Locator to find yours. Or call 1-800-MEDICARE (1-800-633-4227) for the QIO’s telephone number. TTY users should call 1-877-486-2048.
- If you think you are being asked to leave a skilled nursing facility too soon, ask for a review from your QIO. The QIO, under most circumstances, will give you its decision before Medicare coverage of your skilled nursing care ends. Call 1-800-MEDICARE for the QIO’s telephone number.
- For anyone being discharged from a health care setting like a hospital, or Skilled Nursing Facility: Medicare has a Discharge Planning Checklist called, “Planning for Your Discharge” to help you understand everything you need to know before you are discharged. To get a copy, view the booklet “Medicare Coverage of Skilled Nursing Facility Care.” (pdf)
Sometimes people look for a nursing home for a short stay to get help with personal care while recovering from an operation or injury. Others need services for a long time due to chronic conditions or disabilities. Understanding your choices and what’s covered is important.
Tools for Comparing Nursing Homes
Use the Five-Star Ratings of nursing homes in conjunction with the Nursing Home Compare the Care to search and compare nursing homes by city, state, or zip code. Choosing a nursing home that’s near family and friends can be very important to your quality of life in the nursing home. Having family and friends nearby allows for more frequent visits and opportunities for outings. Family members and friends can also talk to the nursing home staff about your care needs, preferences, and gaps in care. Therefore, you may wish to start your search by considering how close you want to be to family and friends, and then use the rating system to compare nursing homes in the area you are considering.
A technical manual containing additional information can be found on the Centers for Medicare and Medicaid Services (CMS) Website.
|Organization||How They Can Help|
|Administration on Aging (AoA)||The Administration on Aging is a Federal agency that can provide a list of the long-term care choices in your state including community services. They can also help you find nursing homes. Visit www.aoa.gov. You can also call 1-202-619-0724.|
|Centers for Medicare & Medicaid Services (CMS)||CMS has free booklets about Medicare coverage and other health related topics. For information about the location and quality of nursing homes, visit www.medicare.gov and select “Compare Nursing Homes in Your Area.” You can also call 1-800-MEDICARE (1-800-633-4227). This is a 24-hour helpline. TTY users should call 1-877-486-2048.|
|Eldercare Locator||The Eldercare Locator is a nationwide toll-free service to help older adults and their caregivers find local services for seniors. Visit www.eldercare.gov. You can also call 1-800-677-1116 (weekdays 9:00 a.m. to 8:00 p.m. Eastern time).|
|Long-Term Care Ombudsman||A Long-Term Care Ombudsman advocates for residents of nursing homes, board and care homes, and assisted living facilities. See pages 59–61 for the telephone number in your state. You may be referred to a local office.|