Nursing facility care. The single most important thing to understand about Medicare and nursing facilities is that Medicare does not pay for long-term care. However, under limited circumstances and for a short time, Medicare Part A or a Medicare Advantage managed care plan can cover a stay in a skilled nursing facility while the person is recovering from a severe mental health episode that landed her in the hospital. The nursing facility stay must follow, within 30 days, a hospital stay of at least three days. And the nursing facility stay must be medically required and prescribed by her doctor to provide her with daily skilled nursing or rehabilitation services while she's recovering from the medical event that put her in the hospital. The coverage can last for up to 100 days, with Medicare paying the full amount for the first 20 days and your family member having to make a co-payment of $133.50 (in 2009) per day for days 21 through 100. For more details about Medicare Part A nursing facility coverage, see our article Understanding Medicare Part A (Hospital Insurance).
Home care. Home care is available under Medicare Part A, Part B, or Part C (managed care) if it's medically necessary for any illness or condition, including mental illness, Alzheimer's, and other forms of dementia. But the rules under which Medicare coverage is available for home care are quite strict, and coverage usually lasts only a short time.
The key thing about Medicare coverage for home care is that it applies only to home healthcare. That means your family member must need skilled nursing care or rehabilitation therapy while she's confined to home because of an injury or illness. It doesn't cover assistance with the activities of daily living such as dressing, bathing, walking, or eating unless these are provided incidentally, alongside required skilled medical care. A doctor must prescribe the home care and it must be provided by a Medicare-certified home healthcare agency.
If the person in your care qualifies, Medicare pays 100 percent of the agency's costs. But the care can continue only as long as the skilled nursing or therapy is required, while she's actually recovering. Home healthcare is covered by Medicare Part A following a hospital stay, or by Medicare Part B if there has been no prior three-day hospital stay. If she's enrolled in a Part C Medicare Advantage managed care plan, that plan provides home care under the same rules, except that the home care agency must be associated with the specific managed care plan.
Although I was already somewhat informed about this topic, I still found beneficial information in your article. Thank you!
I also have a Mother with Alzheimer's Is there a way that I can recieve financial assistance? from Medical or any part of the governments? I pray that anyone who has a family member with this problem can get an answer. Thanks
My father is in the advanced stages of Alzheimers. He has been living in a facilityfor the last 3 years. It is costing my mother almost $7,00.00 a month and this money will soon run out. Does Medicare cover any of this? Will his Aetna insurance cover any of this? Does any one know of some one you can hire to navigate the web of insurance coverage? They don't make it easy to figure out. Thanks God I don't have Alzeimers.
I need to have a wooden handicap ramp built and an 8 ft. by 8 ft. deck from which it will extend. Is there any monetary assistance from any organization? My husband has Alzheimer's and physical handicap. I am finding that it is taking forever to figure out how to do this. Internet sites are so confusing. I have had some bids by local contractors so far, and there is no way I can afford the work. Thanks if you have any information.
As a daughter and caregiver of a mentally ill parent, my mom suffers from paranoid schizophrenia, I can attest to how emotionally difficult their care can be. For support, feel free to visit my blog at mentalillnessmatters.wordpress.com