Medicare and Nursing Home Care
When the needs of an elderly person become more than their family can provide at home, an assisted living situation with skilled nursing care may be the only option. Sometimes the need for a nursing home is relatively temporary. But often it’s a permanent change in the life of the senior. What does Medicare cover? What part would you have to pay?
The answer requires a little delving into. To be clear, Medicare does not provide long-term care. It is useful only for short-term nursing home visits. Medicare Part A will help with the first 100 days of skilled nursing care, but cuts off payment entirely after that. This limited coverage begins by paying 100% of the initial 20 days of a Medicare-approved nursing home stay. Past day 20, Part A pays just 80% of the expenses; the 20% you pay is usually $200 per diem.
As soon as day 100 passes, all of your nursing home costs are on your shoulders. Your better option is a Medicare supplement (Medigap) plan, which covers the 20% from day 21 to day 100, giving you security if your stay is comparatively short. But, like Medicare, Medigap is not long-term coverage — it just fills the gaps Part A doesn’t pay. Once the need for skilled nursing care is definite, you’ll need to find a facility, which accepts Medicare. Fortunately, Medicare.gov has a tool which helps you source the right nursing home in your area. It’s important for you to know that nursing homes are not the only option. The Medicare PACE (Program of All-inclusive Care for the Elderly) program offers in-home skilled nursing care with identical benefits of a nursing home.
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It depends which type you’ll need. Medicare does not cover long-term nursing care, but Part A will pay for the first 100 days of skilled nursing care. It will cover 100% for the first 20 days, and after that pick up 80% of your costs with the remaining 20% your responsibility.
Yes, the right Medicare Supplement plan will help with short-term skilled nursing care — paying the 20% you’d have to pay with Part A from day 21 to day 100.
- Best overall Medicare supplement for new enrollees: Plan G.
- Best overall Medicare supplement before 2020: Plan F.
- Best low cost Medicare supplement: Plan K.
- Best alternative to Plan G Medicare supplement: Plan N.
Medicare Supplement policies are private health insurance designed to cover gaps in Original Medicare. They are also known as Medigap plans. These take care of costs such as copays, coinsurance, and deductibles which can become expensive if you need regular care from a doctor or hospital. If you need medical care while traveling outside the U.S., you can buy Medigap policies to help cover those costs. As a supplement to Original Medicare, you’re required to have Part A and Part B before you canget a Medigap policy. This way, Medicare is responsible for the Medicare-approved costs of the covered care, and the remainder is covered by your Medigap plan.
Optimal coverage comes with higher costs, making Plan F the most expensive Medigap plan. Plan F is known as “first-dollar coverage” and it takes care of everything provided during a doctor or hospital visit. Your only responsibility is for dental, vision, medications, and equipment, such as hearing aids.
The Federal government ended the Plan F option for new enrollees last year to keep the healthcare system from being overused by patients who had their deductibles covered. The next best coverage after Plan F is Plan G.
Medigap Plan G offers every advantage of Plan F except for the deductible, which you have to cover. Because it isn’t as comprehensive as Plan F, Plan G is more affordable.
For people who don’t go to the doctor often, Plan K is worth considering. It is the most affordable because it provides just 50% of Medicare Part B coinsurance, the Part A deductible, blood, skilled nursing, and Part A hospice costs. For comparison, Plan G and others offer full coverage of these expenses, and more.
It’s hard to argue against plans which cut your traditional Medicare costs. For most people, having the extra coverage these supplemental plans provide is common sense, unless they want the specific features of a Medicare Advantage plan.
Most people would benefit from not having to pay out-of-pocket to stay healthy. Medicare supplement insurance or a Medicare Advantage plan offer vital savings now, but are indispensable should a catastrophic health issue occur.
Of the 10 Medicare-approved Medigap plans, Plan G and Plan N are the most popular. Plan F is no longer available to new Medicare enrollees as of 2020, but it is still popular among people who bought this plan prior to 2020.
- Plan F$128–$342
- Plan F (high deductible)$22–$88
- Plan G$106–$325
- Plan G (high deductible)$29–$58
Before getting a Medicare supplement plan, you need to be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance). People with Medicare Advantage Plans who want to go back to Original Medicare can buy a Medigap policy prior to switching.
The security of having lower or no out-of-pocket healthcare costs can offset the premiums you’ll have to pay for whichever Medigap plan you choose, which vary depending on the benefits offered.
The national average cost for Medicare Supplement Plan F is $1,824 annually, which is $152/month; Medigap Plan G will cost you around $143 per month.
Since Plan F was discontinued for new enrollees as of 2020, Plan G offers the most coverage for people 65 and older. It has a lower premium than Plan F and duplicates its benefits, except for the Part B deductible.
It depends on your specific needs, but for most people a Medigap plan is very useful in supplementing the coverage of Medicare Part A and Part B. A Medicare Advantage plan is an affordable way to get healthcare coverage not offered by Original Medicare.
Historically, Plan F has been the most popular because it covers all the out-of-pocket costs Medicare does’t pay for. This includes the 15% extra charge billed by providers who do not take Medicare as full payment.