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Does Medicare Advantage Cover Nursing Home Care?

By Michael Howard
Medicare Advantage includes some benefits that Original Medicare does not. But is nursing home care one of them?

Medicare Advantage, also known as Medicare Part C, offers all of the benefits of Original Medicare (Parts A and B). Unlike Original Medicare, however, many Medicare Advantage plans cover costs associated with vision, hearing and dental care, as well as prescription drugs. Depending on which Medicare Advantage Plan you select, your benefits may also include nursing home care. Let’s take a closer look.

Medicare Advantage and Nursing Home Care

In general, Medicare does not cover nursing home care—because it doesn't cover custodial care. According to the official U.S. government website for Medicare, most nursing home care is regarded as custodial care, which is defined as assistance with day-to-day activities like eating, dressing, bathing, and using the bathroom.

The exception is if you need skilled nursing facility (SNF) care. In that case, Medicare Part A does provide limited, short-term coverage, as long as you:

  • Have Part A and days remaining in your benefit period for use.
  • Have had a qualifying hospital stay.
  • Have confirmation from your doctor that you require daily skilled care that must be administered or supervised by skilled nursing or therapy staff.
  • Need skilled services for a medical condition that is either a hospital-related condition that was treated during  your qualifying 3-day inpatient hospital stay, or a condition that began while you were receiving care in the SNF for a hospital-related illness. 

Medicare defines SNF care as care that must be performed by skilled professionals in order to be safe and effective. Examples include changing sterile dressings and administering intravenous antibiotics.

Under Medicare, you’re required to pay the following for SNF care:

  • Days 1-20: $0 for each benefit period
  • Days 21-100: $185.50 coinsurance per day of each benefit period
  • Days 101 and beyond: All costs

If you need coverage for custodial care, you may be able to get it through a Medicare Advantage Plan. There are six main types of plans:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  • Special Needs Plans (SNPs)
  • HMO Point-of-Service (HMOPOS) plans
  • Medical Savings Account (MSA) plans

In the context of nursing home care, SNP is the one that matters. SNPs come in several forms. The Centers for Medicare & Medicaid Services reports that one of them, Institutional SNPs (I-SNPs), are specifically designed for people who need various forms of qualifying long-term care. 

According to the official U.S. government website for Medicare, the availability of SNPs varies based on your location. Some companies offer SNPs to every Medicare beneficiary in a given state; others limit availability to certain counties. Also, one company could have multiple SNPs for you to choose from, while another may only provide a single plan.

Moreover, an SNP that was available last year might not be available this year, as insurance companies have the annual option to join or leave Medicare.

All SNPs include prescription drug coverage, according to the official U.S. government website for Medicare. Of course, they also feature at least the same coverage as both Medicare Part A and Medicare Part B.

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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.