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Does Medicare Pay for Nursing Home Care or Assisted Living?


Casey: Does Medicare pay for nursing home care or assisted living?

Lee: Ooh. Good question. So what Medicare and Medicare plans will cover is generally skilled nursing facilities. Right? So meaning it’s more of a short term situation. You have a hip replacement, you have a stroke or whatnot, and you go into an assisted living or skilled nursing facility. Medicare plans will normally cover that up to 100 days. There’s a cap on that. Most Medicare plans will actually cover 100% of that cost for the first 20 days. As of 2024, right now. Okay. but then you have some costs for the remaining days, up to 100. But for that, there needs to be progress being made. You’re rehabbing, you’re getting better, and you’re working towards going back home. Right? That’s the difference between skilled nursing and long term care. Long term care is, hey, you’re going there for the rest of your days. Well, that’s six months or six years, whatever the case might be. And Medicare does not cover that long term care protection. So that’s usually a separate policy one way or another, whether that be a long term care policy. There are some other products, some life insurance products, annuities that have some benefits that you can use to help cover and pay for long term care, but Medicare itself does not include that benefit. 

Casey: What about home health care? What if I let’s say I had a hip surgery? I’ll use your example.

Lee:  Yeah. 

Casey: And I’ve come home and I need some nursing for a few days to check my wound, that kind of stuff. But then I have a spouse who can’t lift me, can’t move me, can’t do the dishes. What happens in that situation? 

Lee: Yep. Good question. So yeah, Medicare plans will cover home health care. And in fact usually it’s actually covered 100% by most plans. So yes, if you’re needing rehab care things you can’t do at home, it’s not custodial care. It’s not to come in and do your dishes for you and do your grocery shopping for you. Right? But if it’s to help you with your medications, it’s to help you do your physical therapy. Those types of things. Medicare plans generally cover that pretty generously. 

Casey: Yeah, I think 100% they’re generous. And one of the things that we’ve seen over the last few years, we’ve really identified in our, in our agency is there are plans that are very reasonable monthly that can help with those skilled nursing costs that can help with a cancer diagnosis. They can help with some of those, excuse me, some of those extra things that might you might incur. But for those first 20 days in the skilled nursing, there is no cost to you in most cases. 

Lee: Yep. 

Casey: I want to really point out though, you said something that’s really important. A lot of people say, well, I’ve broken my hip and had a hip surgery and now I’m in skilled nursing, if you go to a skilled nursing facility and you are not progressing or the facility says you don’t, they don’t see you progressing, they’ll they’ll kick you out.

Lee: It’s true. 

Casey: You got to protect yourself. And again, there’s life insurance products, there’s annuities, there’s long term care policies. We help people with those policies to protect them and shield from those. Those events.

Lee: Absolutely.

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