Medicare does not cover custodial long-term care such as assisted living facilities but under specific circumstances may cover stays at a nursing home. Medicare covers a range of health services to beneficiaries in any living situation. However, like most health insurance plans, Medicare doesn’t pay for long-term care costs of residency at an assisted living facility or day-to-day custodial care. Under specific circumstances, if a beneficiary requires a short-term stay for inpatient care in a skilled nursing facility that’s not merely custodial or long-term care, it may be covered by Medicare. When is care at a skilled nursing facility covered? Original Medicare will cover a portion of stays for up to 100 days each benefit period at a skilled nursing facility if a doctor determines that you need specialized health services after a qualifying hospital stay. Assisted living facilities do not count as skilled nursing since intensive medical care are not provided by them. In order for a hospital stay to be considered “qualifying” you must be formally admitted to the hospital for three or more days. Neither time spent there under observation, nor as an outpatient before you are admitted count toward the three inpatient days. The skilled nursing facility must be Medicare-care-certified, and a doctor must determine that you need the care. Contact Kevin Leinum your SAN DIEGO Medicare expert!
