What Does Skilled Nursing Care Mean and Why Does it Matter?
A nursing home lawyer at Zimmer Law Firm can provide you with help if you want to find the right care facility and if you want to make sure that the costs of your care are covered. It is important to understand the different rules for getting various types of care paid for, as you may be surprised to find the care that you need when you get older or when you get sick is not actually covered by Medicare or by any other insurance policies you may have, like Medigap or Medicare Advantage coverage.
Zimmer Law Firm will work with you to understand coverage rules and limitations on coverage and will help you to create a comprehensive plan to pay for care while protecting your assets. One of the key factors that will determine whether or not your care is paid for by Medicare is whether you need skilled nursing care or not. Because the classification of your care as skilled nursing care can make all the difference in coverage options, you should work with an attorney to understand what skilled nursing care means and to make plans for what happens if the care you require isn’t considered to be skilled care.
What is Skilled Nursing Care?
Medicare Part A will pay for you to receive skilled nursing care and will pay for you to live in a skilled nursing facility. If you have a qualifying hospital stay, you are covered by Medicare Part A, and your doctor determines that you are in need of skilled nursing care, Medicare Part A will pay for:
- A shared or semi-private room in a skilled nursing facility.
- Meals and dietary counseling
- Occupational therapy, physical therapy, or speech language pathology
- Medical social services
- Medications you require, as well as medical equipment and medical supplies used by the skilled nursing facility in your care.
- Transportation via ambulance if other transportation would endanger your health and you need to be transported to a nearby facility to receive care that your skilled nursing facility cannot provide to you.
These services can all be very expensive, so it is important to make sure you are able to obtain Medicare coverage to pay for them as long as you are eligible. Medicare makes clear that it will cover these costs under appropriate circumstances.
Why Does Skilled Nursing Care Matter?
The classification of your care as skilled nursing care matters a great deal, because of the fact your care must be classified this way in order for Medicare to pay for you to live in a care facility or to receive care in your home. Medicare excludes coverage for custodial care, even though it covers skilled nursing care. This means if you must move into a nursing home or get long-term care at home, Medicare will pay nothing at all– but if you must move into a skilled nursing facility or get skilled nursing care at home, Medicare pays.
Unfortunately, many people who get sick or who get older end up needing custodial care, not skilled nursing care. Skilled nursing care is care that a professional with some type of medical training must provide. Examples could include changing bandages after a surgery or performing an IV injection. Custodial care, on the other hand, is routine help with daily living such as help using the bathroom, which there is no medical training required to provide.
Custodial care not only is not covered by Medicare, but also is not covered by supplementary Medicare policies like Medigap or Medicare Advantage– and it is not covered by most private health insurance either. You could buy long term care insurance to pay for custodial care, but doing so is often prohibitively expensive as you get older and the coverage you receive may be too limited to actually pay for your care anyway.
Medicaid is a primary source of payments for custodial care, but you have to qualify based on having limited assets. You could be forced to impoverish yourself to get Medicaid to pay for your care, unless you work with an attorney to protect your wealth and get covered.
Getting Help from A Nursing Home Lawyer
Zimmer Law Firm helps you to get Medicaid to pay for your nursing home care or long term care when you need custodial care. You can join us for a free seminar to find out about the Medicaid planning process. If you are ready for personalized help making a plan to get Medicaid to cover the costs of your care, give us a call at 513.721.1513 today.