If you’re receiving care in a nursing home, the time may come where you need to switch to a different facility. Typically, you won’t be transferred to a new nursing home or discharged unless:
- The nursing home is closing
- You haven’t paid your medical bills
- Your transfer or discharge is medically necessary or necessary for your wellbeing and safety
- The nursing home can no longer meet your medical needs
- Your condition has improved and you no longer need nursing home care
If you have to switch to a new facility, you may have questions about how the transfer will affect your Medicare coverage. In this article, we’ll help you understand Medicare coverage for nursing home care and the rights you have under Medicare as a nursing home patient or resident.
What does Medicare cover when it comes to nursing homes?
Medicare does not cover most nursing home stays if personal care is the only type of care you’re receiving. However, Medicare Part A may cover a skilled nursing facility (SNF) stay if your doctor determines that it’s medically necessary after a qualifying hospital stay. The patient cost for skilled nursing facilities typically follows this progression:
- Days 1-20: you pay $0 coinsurance
- Days 21-100: you pay up to $200 coinsurance per day
- Days 101 and beyond: you assume all costs
In-home health care can be an alternative to nursing home care, but for it to be covered by Medicare it must be doctor-ordered care through a Medicare-certified home health agency.
What rules do I have to follow when using Medicare coverage for a nursing home?
In order to use Medicare for a nursing home stay, you’ll need to meet certain requirements. You must:
- Get the care through a Medicare-certified skilled nursing facility
- Get the care from, or under the supervision of, skilled nursing or therapy staff
- Need the care for a hospital-related medical condition or a condition that began while you were getting care in a SNF for a hospital-related medical condition
What protections do I have under Medicare?
As a Medicare recipient, you have specific rights and protections while receiving nursing home care. You have the right to be informed, make your own decisions and to have your personal information kept private. Your rights must be told to you by the nursing home in writing. They also must explain, in writing, how you should act and what you’re responsible for while receiving care.
Your rights as a nursing home patient or resident under Medicare include the right to:
- Be free from discrimination
- Be free from abuse and neglect
- Exercise your rights as a U.S. citizen
- Have your representative notified
- Get proper medical care
- Be treated with respect
- Be free from restraints
- Have protections against involuntary transfer or discharge
- Participate in activities
- Spend time with visitors
- Form or participate in resident groups
- Manage your money
- Get information on services and fees
- Get proper privacy, property, and living arrangements
- Make complaints
Have questions about how Medicare covers nursing homes? Let SelectQuote help.
Entering nursing home care or switching facilities can be overwhelming, but we’re here to make it easier. Our SelectQuote licensed insurance agents can answer any questions you have about Medicare coverage and nursing home care. We quickly and easily compare Medicare Advantage plan rates, saving you time so you can focus on your health and recovery.