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If you’re in a nursing home and unhappy with your care, you may wonder how Medicare coverage works. Are you allowed to change nursing homes? Here’s an overview of your rights while receiving treatment in a skilled nursing facility and what to do if you’re trying to switch.
Medicare does not cover most nursing homes if personal care is the only type of care you need. Also known as custodial care, personal care involves help with daily living tasks, such as getting dressed or using the bathroom. Nursing homes may provide both custodial care and skilled nursing care.
On the other hand, Medicare Part A may cover skilled nursing facilities, such as nursing homes. Your doctor needs to determine that it’s medically necessary for you to get skilled nursing care. In that case, Medicare might cover care in a nursing home or rehabilitation facility after a qualifying hospital stay.
Generally Part A may cover the first 20 days in a nursing home if you qualify. You typically pay a daily coinsurance amount for days 21-100. After day 100, you usually have to pay the entire cost of care.
If you’re in a skilled nursing home, you have certain rights and protections under federal and state law. According to Medicare.gov, you have a right to:
The nursing home can’t discharge or transfer you unfairly. For example, it’s unethical for the nursing home to discharge you because you’re applying for low-income assistance or waiting for Medicaid benefits.
Federal and state law protects you from being unfairly discharged or transferred from a nursing home. According to Medicare.gov, you generally can’t be transferred to a different skilled nursing facility or discharged unless:
If you’re in a nursing home and believe it can’t treat your injury or health condition, or if you’re unhappy with another aspect of your care, you may want to change to a different facility. First, start by speaking to the care team about your concerns. After that, if you still feel that the issues are unresolved, you can talk to your doctor, the supervisor at the skilled nursing home, or a social worker.
If your concerns still aren’t being addressed, you may need to submit a formal complaint to your State Survey Agency (you can look up the contact information for your state here). Every skilled nursing home is required to have a process in place for you to submit complaints, and you have a right to do so without fear of repercussions.
Medicare.gov has published a handy checklist to help you evaluate the safety and quality of care at the skilled nursing facility.
If you need help filing a complaint against your skilled nursing facility, contact your State Health Insurance Assistance Program for free counseling services.
If you’d like to find Medicare plan options, eHealth’s plan finder tool is simple to use from the convenience of your home. To get started, enter your zip code into the box on this page to view plan options in your location.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.