Guide to Choosing Nursing Home When You Have Medicare Coverage
If you’re facing a nursing home stay for yourself or a loved one, no doubt you want to find the highest quality facility you can. But how do you know what the best nursing homes are? Here’s some information for you.
When would I need a nursing home?
Whether to enter a nursing home can be a hard decision. Sometimes in-home care is all you need. For example, suppose you don’t need skilled nursing care most of the time, but you need help dressing, bathing, preparing meals, or getting to doctor appointments. You might be able to rely on friends, family, local volunteers, and/or a home health-care agency.
But perhaps you need frequent skilled nursing care –administration of medications or wound care, for example – and you have trouble getting around on your own. Unless you can assemble a skilled nursing team to help you at home, you probably need to be in a skilled nursing facility, like a nursing home. They typically provide 24-hour supervision, according to the Department of Health & Human Services (HHS).
If it makes you feel any better about it, know that you have a lot of company. The Kaiser Family Foundation reported in 2015 that 1 in 3 people aged 65 or over will need nursing home care at some point. About 1,400,000 people in the U.S. were in nursing homes when the report was published.
How can I find a good nursing home?
There’s good news for those worried about finding a nursing home that has passed inspection. Medicare actively monitors many nursing homes across the U.S.
Medicare and Medicaid certify certain nursing homes. Then, a state survey agency inspects these certified nursing homes. The state gathers information about the quality and sends it to Centers for Medicare & Medicaid Services (CMS) for approval. Medicare rates the nursing homes and makes these “star ratings” public for you to see.
What kind of nursing home data does Medicare publish?
There’s a lot of information that goes into the Medicare star ratings of nursing homes. Here’s a sampling of some of the quality measures:
- Staffing levels
- Medication management
- Fire prevention
- Emergency readiness
- Protection from physical and mental abuse
- Food safety
Does Medicare cover nursing homes?
Medicare has limited coverage for nursing homes. In most cases, Medicare Part A may cover up to 100 days in a nursing home, per benefit period. A benefit period starts when you’re admitted as an inpatient in a hospital or skilled nursing facility. It ends when you haven’t had inpatient care for at least 60 days in a row.
Medicare Part A usually pays for all covered care for the first 20 days, and charges a daily coinsurance amount for days 21 through 100. A deductible may apply.
You may be able to buy a Medicare Supplement insurance plan to help pay for your Medicare out-of-pocket costs, like coinsurance. Medicare Supplement insurance typically pays for an additional 365 days of Medicare Part A inpatient hospital costs once Medicare coverage runs out. But when it comes to nursing homes, Medicare Supplement insurance plans generally don’t cover long-term care or nursing home costs after the first 100 days.
How can I access Medicare’s nursing home star ratings?
Visit Medicare.gov for this information, and type in your zip code.
You can also type in your zip code right on this page to start comparing Medicare Supplement insurance plans, Medicare prescription drug plans, and Medicare Advantage plans. You can enroll online when you’ve decided on a plan.
The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.