When you grow older, long-term care may be necessary depending on how you are when living independently. If you are a senior citizen and realize that getting dressed, doing laundry, or managing your medications is not as easy as it used to be, then you might want to consider moving to a care home. According to the National Center for Biotechnology Information (NCBI), about 1.5 million seniors live in a nursing home, and 1 million live in an assisted living facility (care home). However, since Medicare is the primary insurance for most senior citizens, will Medicare cover care homes? Let’s first discuss what a care home is.
What is a care home?
A care home is a residential facility that provides living quarters, meal services, and typically aid with daily activities, such as laundry, bathing, and getting dressed. Care homes are not required to have 24-hour medical care. You may find one care home that offers part-time medical care, whereas another care home might not offer any at all.
Most care homes have a positive, family-like atmosphere. Care homes are traditionally in residential-style neighborhoods and house many senior citizens. The residents that live in these homes will have their own private rooms for sleeping but will share recreational and dining areas.
Seniors can benefit by living in a care home to help fight against loneliness and depression. When living in a care home, you will be surrounded by people who are similar in age. You can interact with the other residents every day by either participating in social activities, having a lunch date, or taking nighttime walks.
How Medicare covers care homes
Medicare comes in two parts, Part A and Part B. Medicare Part A covers the inpatient care you receive while an inpatient in the hospital. Medicare Part A will also cover post-hospital services, such as hospice, skilled nursing, and some home care. Medicare Part B covers outpatient services, such as doctor’s visits, ambulance rides, and durable medical equipment.
Medicare only covers short-term care, never long-term. Medicare will also only cover services that are deemed medically necessary by a physician. If you receive medically necessary medical care inside a care home by a physician willing to bill Medicare, Medicare will cover the Medicare-approved charges.
For example, if you have an accident inside the care home and require an ambulance, Medicare will likely cover the Medicare-approved charges of that ambulance ride. Another example would be if you were to require hospice. Since hospice is typically short-term, Medicare will likely pay for the Medicare-approved charges of your hospice services (if the hospice center accepts Medicare).
However, Medicare will not pay for a caregiver to stay with you long-term at a care home. Medicare will also not pay your expenses that come along with a care home, such as rent, meal services, or custodial care. The costs that come with a care home will be 100% at your expense. But, if you were to receive medical care inside a care home and it’s medically necessary, Medicare will likely provide coverage.
Medicare costs for care homes
As mentioned, Medicare Part A covers inpatient care. If you become an inpatient regardless of living in a care home, you will pay the Part A deductible, which is $1,484 per 60-day benefit period in 2021. After you pay the Part A deductible, Part A fully covers your inpatient stay for up to 60 days.
If you receive outpatient healthcare services, you will pay the Part B deductible before Medicare pays out. In 2021, the Part B deductible is $203. Once you pay the Part B deductible, Medicare will pay an 80% coinsurance for your Medicare-approved service. You will pay the remaining 20% coinsurance for your outpatient services.
Medicare will cover your medical care when living in a care home if the physician is willing to bill Medicare and the charges are approved by Medicare. Medicare will not cover the costs of a care home, such as your rent, groceries, or any custodial care you receive at the care home. Medicare will not cover long-term care, only short-term.