Previously, I explained how Medicare coverage works. Specifically, how it works when it comes to billing through nursing homes. As you can probably imagine, I couldn’t go over everything when it comes to the ins and outs of such a complex topic.
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But today, I want to go into a bit more detail about the inner workings of this federal healthcare program and how to collect on payments through them. On the other hand, if you are looking for yourself or a family member or friend to find a nursing home, stick around! This information will help you, too.
Nursing homes can offer many types of services. While personal care services, such as assistance with bathing and dressing, aren’t covered by Medicare there are services that are.
For example after a hospital stay, a doctor may decide to send their patient to a skilled nursing facility (SNF) to receive specialized nursing care. This is when Medicare Part A comes into play. This plan covers SNF care for a limited time if:
* The patient has Part A and has days left in their benefit period to use.
* The patient has a qualifying inpatient hospital stay. More specifically,
they were in the hospital for at least three consecutive days.
A doctor must also certify that a patient needs daily care from skilled nursing staff. This sort of care is different from personal care services because they can only be safely and effectively performed by healthcare personnel.
So long as the nursing home care is not exclusively custodial, an individual should have coverage. Note that a patient must check in to a skilled nursing facility within 30 days of leaving the hospital. On top of that, it must be for the same illness or condition related to the hospital stay.
When talking SNF coverage, here are some of the most common services included:
* Prescription medications.
* Changing sterile dressings.
* Nutrition-related services and meals.
* Rehabilitation services such as physical, occupational, and speech therapy.
Medicare Part B helps to cover additional medically necessary services for patients in a nursing home setting. These services or supplies help to diagnose or treat medical conditions. Services must also meet accepted standards of medical practice.
Medicare Part B also covers preventative services, or healthcare that prevents illness or detects it at an early stage. This is when treatment is most likely to work best. So long as the provider accepts Medicare Part B coverage, these services may include:
* Clinical research.
* Ambulance services.
* Durable medical equipment.
* Mental health services.
* Outpatient prescription drugs.
Note that Medicare Part B covers 80 percent of the cost of medically necessary services.
The last plan we will be going over today is the Medicare Advantage Plan, sometimes called “Part C” or “MA Plans”.
Private companies offer these plans which are first approved by Medicare. Extra coverage from MA Plans may include vision, hearing, dental, and/or health and wellness programs. The plan also usually includes drug coverage, or Medicare Part D.
Medicare coverage in nursing homes and other assisted living facilities plays a critical role in providing care to the elderly and disabled. It is a safety net that serves individuals who require skilled nursing care who might otherwise be unable to afford it. Although Medicare coverage does come with limitations and eligibility requirements, it is still an important resource for millions of Americans.
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