Medicare itself does not cover traditional nursing home care. Medicare only covers skilled nursing care or other medical care needs inside a nursing home facility. Nursing homes are generally places of custodial care. All care paid for by Medicare must be medically necessary.
Nursing home care in its traditional form is not medical care but is instead custodial care. They may provide some limited medical care (which may be paid by Medicare) but the focus is actually on supporting the activities of daily living (ADL) for the client instead. In their normal capacity a nursing home is helping with bathing, toileting, feeding, and other things which do not require formal medical staff to handle. Nursing homes though typically do have at least one Registered Nurse (RN) on staff at all times to handle medical issues which do come up.
Medicare Supplements are designed to fill in gaps left when someone uses Medicare as their primary health coverage. There are several different plans, all standardized, that fill various holes in Medicare coverage.
I will focus on F and G standard policies because they are among the most popular Medicare Supplement (often called a medsupp) policy. Also, these two plans are virtually identical, with F paying the Medicare Part B deductible and G not paying that hole. These two plans are the most comprehensive medsupp plans, plugging virtually all holes left by Medicare alone. Although they provide protection for emergency care outside the country not covered by Medicare, neither F, G, or any other medsupp will cover nursing home care when it is custodial in nature.
Many medsupp plans provide assistance for holes in Medicare coverage of skilled nursing care inside of a nursing home. The member must enter the nursing home after a 3 day stay in an acute care hospital and deemed medically necessary to receive care in a skilled nursing facility. The care must ultimately be prescribed by an attending physician. These things do not happen for custodial care. Thus, in reality despite the fact much skilled nursing care is provided within nursing homes, nursing home care as most think of it is not covered. Between Medicare and plans F and G up to 100 days is covered by the insurers.
Medicare was established to help with medical care needs. Convalescent or custodial care is not a medical need but instead addresses assistance with activities of daily living. The ADLs are addressed in Long Term Care Insurance (LTCI) plans. Medicare Supplements cover the part of the healthcare expenses authorized by Medicare but which are otherwise considered to be member responsibility or are one of the few limited items they cover above and beyond what Medicare pays. These are care outside of the USA and extended hospital stays a year beyond where Medicare stops paying.
LTCI plans are there to cover custodial care or nursing home care where there are no medical needs being treated. LTCI plans are subject to full underwriting in order to have one issued. The cost for the plan varies based on age at issue, coverage levels, and medical status. These policies are designed to cover many different needs related to the ADLs so an LTCI should not be thought of as only nursing home care since in reality, they cover home care and assisted care as well. Again all of these are convalescent or custodial care situations where Medicare does not offer any benefits.
To recap neither, Medicare or a medsupp plan covers nursing home care in its traditional sense. LTCI policies are available to meet those needs. Having both ensures when the need arises both medical and nursing home care needs can be covered at least substantially by insurance companies.
Establishing a LTCI policy in addition to a medsupp plan is a useful way to cover both needs. For those looking for help in Texas, Arizona, Florida, with their medsupp and long term care a broker with expertise in these areas is very beneficial. They can provide expert advice on securing the right LTCI plan for your specific unique needs.
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