The three levels of Nursin Home Care and how payment is made

There are three general levels of nursing care. There's a great deal of confusion about them and, what, if anything, Medicare and various insurance plans pay for the three types of care. Medicaid (Medi-Cal in California) covers all levels of care.

For a better understanding, let's consider some basic definitions:
I. Custodial Nursing Home Care
Provides assistance in the activities of daily living (eating, bathing, and mobility, for example) and can be given by a home health aide rather than a licensed professional.
a
 Medicare pays nothing.
b
Medicare Supplement plans pay nothing.
c
 Group and individual plans usually pay nothing.
d
 Some individual plans (long term care or nursing home insurance policies) can pay under certain circumstances.
 
II. Intermediate Nursing Home Care
Is usually prescribed for patients who need medical attention on a 24 hour basis but do not require constant skilled nursing care. This service can be provided by a trained or certified aide or licensed professional.
a
 Medicare pays nothing.
b
Medicare Supplement plans pay nothing.
c
 Group and individual plans usually pay nothing.
d
 Some individual plans (long term care or nursing home insurance policies) can pay under certain circumstances.
 
III. Skilled Nursing Home Care
Is the highest level of treatment a nursing home resident can receive. This type of care provides comprehensive, planned care, including rehabilitative or restorative therapy, medical or drug therapy, dietary supervision, and/or professional observation and judgment - vital health services you probably would need on a SHORT-TERM basis to recover initially from a serious accident or illness. Skilled care is the only kind of nursing home care covered by Medicare and some Medicare supplement plans - and it is covered ONLY in Medicare-approved skilled nursing facilities.
(NOTE: Most nursing homes in California are Medicare certified or approved institutions.)
a
 Medicare - in Medicare-approved institutions only, pays 100% of eligible expenses for 20 days. For the next 80 days, pays all but $65.00 a day. Thereafter, pays nothing.
b
Medicare Supplements - Varies from nothing to the Medicare co-insurance from days 21-100 to a portion of the daily cost beyond the 10Oth day (for skilled care only).
c
 Group and Individual plans - May pay for very limited post hospital convalescent care.
d
 Some individual plans (long-term care or nursing home policies) can pay under certain
circumstances.
 
IV. Home Health Care
Is another type of long-term care that may be covered.
a
 Medicare covers home health care ONLY if it is part-time intermittent SKILLED care, physical therapy, or speech therapy. If you need one of these three, you can also receive occupational therapy, home health aids, and medical social services.
b
Medicare supplement plans pay nothing.
c
 Group and individual plans may pay for very limited post hospital convalescent care. Some individual plans (long-term care or nursing home policies) pay a limited amount usually after a set number of days in a nursing facility.
 
Note: Medi-Cal also covers home health care, but does not require the three trigger services (i.e., intermittent skilled care, physical therapy and speech therapy) required by Medicare.
 
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