Medicare covers up to 100 days of SNF care per benefit period. Learn what happens when your coverage runs out, how to qualify for a new benefit period, and alternative options for continuing care. If the nursing home tells you that treatment will be stopped because the resident has stagnated or has not progressed and that Medicare will not pay, you can ask the nursing home to submit a bill to Medicare (this is known as a “demand bill”). If you or someone you know is considering nursing home care, make sure you fully understand what services are covered and what Medicare doesn't pay for. Part B covers certain medically necessary services (such as diagnosis and treatment), as well as the costs of physical, occupational and speech therapy after 100 days of being at the facility.
Ask your provider if you are eligible for home therapy through the Medicare home health benefit, or if you could be treated safely as an outpatient. An outpatient is a patient who has not been formally admitted to the hospital as an inpatient. And if you recently moved to an assisted living home, Medicare will still cover the same services it covered before you moved. Assisted living communities are all unique, with different features and services that range from dining rooms and common social areas to libraries and movie theaters. Your coinsurance is determined by the number of days you have been at the facility during each benefit period.
The nursing home may say that Medicare will no longer pay for therapy because the resident is not getting better. Medicare generally doesn't cover long stays in skilled nursing facilities, such as nursing homes. This will allow Medicare to make the decision about therapy instead of relying solely on the decision of the nursing home. Medicare covers certain costs for people with dementia, such as hospital care, cognitive evaluations, home health care, palliative care, medications (depending on Part D), and care in specialized nursing homes. There are several ways to finance the costs of assisted living, from personal savings to Medicaid exemption programs.
Nursing homes offer a safe alternative for older adults who need high-level, long-term care, beyond what assisted living can provide. Usually, in these centers or communities, several levels of care can be provided, and people pay more for the greater amount of care they need. Before you or someone in your care enter a nursing home, it's essential to understand what Medicare will and won't cover, Newsholme advised.
