Does Medicare provide for payments to a nursing home?

Answer 1

The thing to know about Medicare is that this program is insurance for acute illnesses. This means that if you are enrolled in Medicare Parts A and Part B bills pertaining to procedures that are deemed "medically necessary" will be paid for.

"Medically necessary" is the most important term. Medicare will not pay for any procedure or care that does not fit in this definition. Yes, Medicare will pay for nursing home care that might be needed by someone who needs care after a hip replacement or after a hospitalization for some other health episode. But, if the doctor determines that there will be no further recovery for a person--say someone who just has suffered a stroke--Medicare benefits basically end. This is because Medicare does not pay for the costs of day-to-day care if the care will not improve the person's health after acute health episode.

Many--and I do mean a whole lot of people I know-- get Medicare confused with Medicaid. Medicaid is a health insurance program for the poor or "medically indigent." Medicaid is only available to folks who meet stringent financial guidelines. If one qualifies for Medicaid--and folks at the state level determine this--then costs of the nursing home stay will be paid. Of course, someone pays this cost, because nursing homes have to pay their bills. Taxpayers pay the costs for folks on Medicaid. The costs for nursing home stays are shared by the state government and by the federal government.

There is a lot more to know about Medicare and about Medicaid. You can get information from the CMS website, I'm sure, but my experience is that a lot of the information there is written by bureaucrats--it's difficult for the average person to decipher. You might consider calling your local area agency on aging. If you live in the United States or one of the territories, there is one serving
your area. You can call toll-free 1-800-677-1116 to find out the one serving you. Each area agency on aging has professionals available to answer questions like this one. You will most likely find the people there friendly and very helpful.

If you do contact your local area agency on aging and like the help that they give you, let your local county officials and your folks in Congress know, too. Area agencies on aging don't have big budgets for advertising and certainly don't have budgets that support campaign contributions!

Hope this helps! Best wishes!

Answer 2

Yes and let me tell all you Medicare pt. you do not have to pay extra, if a doctor or facility takes Medicare they have gone into a contract with them. Which simply means they are not allowed to ask for the other percentage that it will not pay, if they want more money tell them you need to talk to the patient advocate and that it is against the Medicare aggreement plan and watch how quick you get a paid off statement, thats why the doc's I've worked for won't take it. Now Medicare will pickup for a nursing home after the pt. has no money left and only after a certain amount of time that the pt. gives all their assets to another person. Hope this helps.