Know Your Coverage: Nursing Home Approval or Bust

By The Care Centers.

When the time comes to move into a nursing home, you will be faced with many decisions. Two of the most important decisions you will make throughout the process is where you will stay and how you plan to pay for the services (Live Where You’re Comfortable: Funding and Family). Medicaid and Medicare often cover some expenses in nursing homes, assisted living facilities, home care, and other independent care facilities. Before you jump the gun and start making yourself cozy down the road, consider what exactly your insurance covers and what you may need to pay out of pocket. 

Medicare: Facing the Facts

If you are covered by Medicare, you may be in for a ride when choosing a nursing home facility. Often times, Medicare will only cover a nursing home stay IF the care is considered medically necessary. Medicare does not cover long-term stays and is focused on short-term stays involving acute care. Skilled nursing facilities are often not covered by Medicare as they are considered long-term care. If the care in a nursing facility is short-term including home health care services, Medicare will cover the expenses. Of course, you must meet certain requirements. Medicare does cover hospice in the event a patient’s prognosis is a lifespan of less than 6 months due to a terminal illness. Medicare covers the entire hospice stay including the prescription medications, counseling, and more. 

Medicaid: Breaking Down the Facts

Medicaid is designed to cover your long-term care services including nursing homes and at home care. The program is aimed to help low-income families. Medicaid pays for the services of a nursing home, which makes it a better option than Medicare; however, some of the stipulations prevent families from applying for it.  Medicaid requires that those who wish to participate in the program meet all of the requirements prior to being approved. Nursing facility services are approved by Medicaid and paid for by the program. The program often includes rehabilitation programs, skilled nursing services, and long-term care. Since Medicaid requirements and rules vary by state, it is vital to speak with your local Medicaid office to discuss your eligibility. 

Choosing a Nursing Home

Once you have decided how you plan on paying for your care, it is time to focus on choosing the right nursing home. When you begin searching, narrow down your list by qualified homes. Not every independent care facility will be approved by your funding source. 

Once you have the list made, you can then begin comparing the benefits, cons, and prices of each. Determining the pros and cons of each home will give you an idea of which home matches closely with your care needs. 

Lastly, narrow down your list further based on your determinations. Visit each of the homes and take a tour. You should take note of room size, cleanliness, and overall friendliness of the staff and residents.

Sign Up and Get Approval

Once you have the home selected, now is the time to speak with the insurance company and secure your enrollment at the nursing home. You will soon be able to get the care and help you need while having the peace of mind knowing your costs are covered (Using Your Veteran Benefits: Choosing a Health Care Facility). 


Tags: Nursing Homes