What Medicare does and does not pay for

Does Medicare pay for assisted living or long-term care?

No: Medicare does not pay for assisted living, for room and board anywhere, or for long-term custodial care such as help with bathing and dressing over months or years.

That surprises many families who assume Medicare covers whatever an older person needs. Medicare is health insurance; long-term care is paid privately, by long-term care insurance, by VA pension or by Medicaid.

When does Medicare pay for a nursing home stay?

Medicare Part A pays for up to 100 days of skilled nursing facility care per benefit period after an inpatient hospital stay of at least three days, when the person needs daily skilled nursing or therapy; days 1 to 20 are fully covered and a daily coinsurance applies after that.

Time spent under observation status does not count toward the three-day stay. Ask the hospital case manager at Our Lady of the Lake, Baton Rouge General or Ochsner whether your parent is an inpatient before planning a skilled nursing stay.

What does Medicare cover at home?

Intermittent skilled nursing, physical, occupational and speech therapy, and part-time home health aide visits for a homebound patient under a doctor's plan of care, delivered by a Medicare-certified home health agency.

Medicare does not cover hourly aides for general supervision or round-the-clock care. The Baton Rouge area's licensed home health agencies are listed in our directory.

What does the Medicare hospice benefit cover?

For a patient whose doctor certifies a life expectancy of six months or less if the illness runs its normal course, hospice covers the care team, medications and equipment for the terminal illness, at home, in an ARCP or in a nursing home.

LDH's roster lists 20 licensed hospices with offices in the Baton Rouge area, among them Gentiva, Amedisys Hospice, Audubon Hospice Care, Bridgeway Healthcare & Hospice; hospices licensed in other regions may also accept patients here.

Hospice does not cover room and board in an ARCP or nursing home. Patients can leave hospice and return later.

Where can Baton Rouge families get free Medicare counseling?

From the Louisiana Department of Insurance's Senior Health Insurance Information Program (SHIIP) at 1-800-259-5300, which offers free, unbiased counseling on Medicare, Medicare Advantage, Part D and Medigap.

Medicare Advantage plans in the Baton Rouge market often require prior authorization for skilled nursing and home health. Ask the plan before discharge, not after.