Medicare’s skilled nursing facility (SNF) benefit does not cover most nursing home care. Medicare will pay the cost of some skilled care in an approved nursing home or in your home, but only in specific situations. The SNF benefit only covers you if a medical professional says you need daily skilled care after you have been in the hospital for at least three days and you are receiving that care in a nursing home that is a Medicare-certified skilled nursing facility. While Medicare may cover up to 100 daysof skilled nursing home care per benefit period when these conditions are met, after 20 days beneficiaries must pay a coinsurance fee. In 2008, that coinsurance was $128 per day. While Medicare may pay for nursing home care sometimes, it does not cover the costs of care in assisted living facilities.
While many people would like to receive care in their own homes, Medicare does not cover homemaker services. In addition, Medicare does not pay for home health aides to give you personal care unless you are homebound and are also getting skilled care, such as nursing or therapy. The personal care must also relate to the treatment of an illness or injury, and you can only get a limited amount of care in any week.
You should not rely on Medicare to pay for your long term care needs.
Medicare Supplement Insurance
Medicare supplement insurance is private insurance that helps pay for some of the gaps in Medicare coverage, such as hospital deductibles and excess physician charges above what Medicare approves. Medicare supplement policies do not cover long-term care costs. However, four Medicare supplement policies—Plans D, G, I and J—do pay up to $1,600 per year for services to people recovering at home from an illness, injury or surgery. The benefit will pay for short term, at-home help with activities of daily living. You must qualify for Medicare-covered home health services before this Medicare supplement benefit is available.