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The Insurance Buying Guide: What About Medicare?

As we mentioned in the previous chapter, Medicare also may pay for some nursing home costs. However, custodial care is not a covered expense in accordance with Medicare provisions. Medicare will pay only for skilled nursing care -- and then only if you are an inpatient in a Medicare-certified skilled nursing facility. Many nursing homes are not certified by Medicare, because they provide more custodial care than skilled care.

Since Medicare will pay only for rehabilitative services, it also requires prior hospitalization before admission to the skilled nursing facility. For example, say you're hospitalized for major surgery. Following the hospital stay, the doctor orders you to a skilled nursing facility for necessary physical or rehabilitative therapy. Medicare would normally provide some benefits for this situation.

However, if a doctor suggested that a senior citizen be placed in a nursing home for routine custodial care, Medicare would not provide benefits.

When Medicare does pay, it fully covers the first 20 days of confinement in a skilled nursing facility -- if you are receiving skilled nursing care.

After the first 20 days, you will be required to make co-payments for skilled care. The amount of these co-payments changes each year and is applicable to the next 80 days of confinement. Typically, this co-payment feature will result in a Medicare payment of approximately 10 percent of the expense -- provided the care is skilled care.

After 100 days of confinement, Medicare pays nothing.

Nationwide, Medicare pays for less than 3 percent of total nursing home expenses each year.

It is also important to note that Medicare supplemental insurance policies do not provide coverage for custodial care. Both Medicare and Medicare supplement insurance are designed to cover only acute medical care.

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