As people get older, their need for assistance with their daily activities increases. This is where nursing care comes in. It helps the elderly maintain their independence and improves their overall wellbeing. However, nursing care can be expensive.
Therefore, it is essential to know what your insurance covers to avoid any financial strains.
What is Nursing Care?
Nursing care is a form of medical care provided by a licensed professional nurse. The care can be provided in hospitals, residential care facilities, nursing homes, or at home. It comprises a variety of services, including but not limited to:.
- Wound care
- Medication management
- Feeding
- Bathing
- Mobility assistance
- Toileting
The levels of nursing care vary, depending on the individual’s need. Some people might require 24-hour care, while others can manage with hourly care.
Medicare Coverage
Medicare is a federal health insurance program for people who are 65 or older, or for people of any age with certain disabilities. According to Medicare.gov, Medicare covers skilled nursing care in a skilled nursing facility under specific conditions.
These conditions include:.
- The patient must receive skilled care from licensed nurses or physical, occupational, or speech therapists.
- The patient must have a qualifying hospital stay, which means a hospitalization of at least three days.
- The patient must be admitted to a Medicare-certified skilled nursing facility within 30 days after leaving the hospital.
- The care must be for a condition that was treated during the qualifying hospital stay.
If these conditions are met, then Medicare covers the first 20 days of skilled nursing care entirely. From day 21 to day 100, Medicare covers the cost partially, and the patient pays a copayment.
However, Medicare does not cover long-term nursing home care.
Medicaid Coverage
Medicaid is a state-run health insurance program for people with low income. Medicaid provides coverage for nursing care for eligible individuals. The coverage varies from state to state.
If a person meets the eligibility criteria, Medicaid will pay for nursing home care. The eligibility criteria include:.
- Be 65 or older, or have a disability
- Have income below a specific threshold
- Have assets below a specific threshold
Medicaid covers the cost of nursing home care entirely for eligible individuals. However, Medicaid does not typically cover in-home nursing care. In some states, Medicaid covers home care under a Medicaid Waiver program.
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Private Insurance Coverage
Private health insurance plans offer varying levels of coverage for nursing care. The coverage depends on the insurance company and the policy selected.
The policies that offer nursing care coverage often come with monthly premiums and yearly deductibles. Before selecting a policy, it is essential to read and understand the policy’s terms and conditions.
Long-Term Care Insurance
Long-term care insurance is a policy that covers the cost of nursing home care and in-home nursing care. The policyholder pays monthly premiums, and if they need nursing care, the policy pays for it.
Long-term care insurance policies vary based on the insurance company, the policyholder’s age, their health condition, and the policy’s purchased features.
Veterans Affairs Coverage
The Department of Veterans Affairs (VA) provides benefits for veterans, including health care benefits. The VA provides nursing care through the Community Living Centers (CLC) facilities or contracted nursing homes.
To receive nursing care from the VA, the veteran must meet the eligibility criteria. The eligibility criteria include:.
- Having served on active military duty and received a discharge other than dishonorable
- Having a service-connected disability
The eligibility criteria also consider the veteran’s income and assets. If a veteran meets the criteria, the VA pays the cost of nursing care entirely.
Out-of-Pocket Payments
Out-of-pocket payments are self-funded payments for nursing care. Out-of-pocket payments are an option if a person does not have insurance to cover the cost of nursing care or if they have exhausted their insurance coverage.
The cost of nursing care varies depending on the level of care needed, the location, and the facility or agency providing it. Before opting for out-of-pocket payments, it is essential to understand the costs and the types of nursing care available.
Conclusion
Understanding nursing care coverage is essential to plan for the elderly’s long-term care. Medicare covers short-term skilled nursing care, while Medicaid covers the cost of long-term nursing home care.
Private insurance and long-term care insurance provide additional coverage options for in-home nursing care and nursing home care. Veterans Affairs coverage is available for eligible veterans. Out-of-pocket payments are an option when insurance coverage is not available or is exhausted.
