Moving into assisted living or a nursing home can be a difficult transition. Knowing how to navigate your Medicare options can make your decisions easier.
Does Medicare Advantage Cover Long-Term Care?
Medicare does not cover the cost for long-term assisted living facilities. But some Medicare Advantage plans, also known as Medicare Part C, pay for several related services.
More than 22 million Americans are already enrolled in Medicare Advantage and there are now more than 3,100 plans available nationwide.1
Families, social workers, doctors, and other healthcare workers can help figure out the best care arrangement for you or your loved ones. We can help you understand your options and get you started on the path to enrolling in a Medicare Advantage plan.2
What is Medicare Advantage?
Medicare Advantage is a type of all-in-one health plan that includes Medicare Part A, Medicare Part B and, often, Medicare Part D,3 which is prescription drug coverage. If you are a current Medicare beneficiary, you will continue to receive the same Original Medicare services when you sign up for Medicare Advantage.
Medicare Advantage plans can also include coverage for services not covered by Medicare Parts A or B, such as vision, hearing and dental coverage, as well as transportation to doctors’ offices and gym or health club memberships.
How Can You Purchase a Medicare Advantage Policy?
Plans are offered by private companies and vary based on where you live. You can start your research online by looking up plans offered in your area.4
You may be able to join online depending on the plan’s website, or you can contact the plan to get a paper enrollment form. To get answers to any questions, to enroll over the phone or to arrange payment if your plan has a premium, you can call 1-800-MEDICARE (1-800-633-4227).
When you are ready to join a Medicare Advantage plan you will need to provide your Medicare number and the date your Parts A and B coverage began. Both pieces of information can be found on your Medicare card.5
Does Medicare Advantage Cover Skilled Nursing Facilities?
While none of the Medicare plans cover the cost of living in nursing homes or assisted living facilities, Medicare Part A and Medicare Advantage do cover a stay in a skilled nursing facility.
When Would You Need Skilled Nursing Care?
Skilled services are often needed for an illness or an injury that requires daily, inpatient care. You receive these services until doctors clear you to return home or to a long-term care facility. Examples of a long-term care facility include a nursing home or an assisted living facility.
Conditions that require a stay in a skilled nursing facility include strokes, broken bones, wound care or post-surgery care. You may also need to transition to a skilled nursing facility after being hospitalized for an illness so that you can work with nurses, physical therapists and occupational therapists before you return home.
When Does Medicare Advantage Cover Skilled Nursing Care?
Medicare Part A and Medicare Advantage will cover a skilled nursing facility stay for up to 100 days as long as you meet a list of criteria.
Those criteria include:
- Skilled nursing services and/or therapy services that are required on a daily basis as ordered by a doctor.
- Care for a medical condition that was treated during a three-day hospital stay.
- Your skilled nursing facility is a Medicare-approved facility.
Work with your doctor, your healthcare providers, your social worker and your family to find the right facility to meet your needs.
Does Medicare Advantage Cover In-Home Support Services?
Switching to a Medicare Advantage plan means you may be able to get coverage for some in-home services and possibly lower your out-of-pocket costs.
The additional coverage options, restrictions and out-of-pocket costs may vary from plan to plan, and not every plan covers in-home support services. Some plans require you to get prior authorization from your doctor for in-home services while others may require that your care come from an agency that contracts with your specific plan.
These supplemental benefits that are offered only through Medicare Advantage focus on your physical and emotional well-being, safety and your quality of life.6
Home Safety Improvements
Medicare Advantage plans now have the option of covering certain improvements to make your home safer and easier to navigate. These improvements include installation of shower grips and toilet rails, wheelchair ramps and wider door openings.
You may also qualify for additional home services, such as carpet cleaning and the installation of air purifiers to prevent allergy and asthma attacks.
Personal Care Services
More and more healthcare professionals recognize that quality of life is an important factor in your physical, mental and emotional well-being. Medicare Advantage plans now have the option of offering a host of personal care services to improve your quality of life. These services can include assistance with bathing, dressing and oral hygiene.
You can get transportation to and from medical appointments whether you are living at home, in assisted living or a nursing home.
With your Medicare Advantage plan, you may now have access to a host of covered nutrition services, including meal and produce delivery, meetings with a nutritionist, counseling on diabetes-friendly and heart-healthy diets and even healthy cooking classes.
Adult Day Care
Recognizing that a safe place to socialize has physical and emotional benefits for patients and caregivers, Medicare Advantage may pay for some or all of adult day care services.
Sometimes the safest place to get answers to your medical questions is right in your own home. Medicare Advantage covers telehealth, or e-visits, with your healthcare providers by video or phone.
Over the Counter
In addition to prescription drug coverage, Medicare Advantage plans may pay for several over-the-counter items, including pain relievers, cough medicine, vitamins, bandages and toothpaste.
Keep in Mind
There is no one-size-fits-all when it comes to healthcare and insurance. Shop around and talk with trusted medical professionals, insurance experts and your family to find the best Medicare Advantage plan for your needs.