Will Medicare / Medicaid Cover Skilled Nursing in Georgia?

Medicare defines skilled care as “nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel.” Skilled nursing services are available in a hospital, of course, or in a designated skilled nursing facility (SNF). Because this is an advanced and often complex level of care, it can be quite expensive. So will Medicare or Medicaid help cover the cost?.

In short, yes. Both Medicare and Medicaid will pay for skilled nursing services in Georgia. However, coverage for each program is different and the details can be confusing. Misunderstandings can lead to denied treatment, unexpected costs and added stress at a time when seniors should be focusing on their health.

It is best for seniors and their families to learn about skilled nursing options before you ever need skilled nursing care. It is also important to understand your coverage and rights as a Medicare or Medicaid participant. This overview of each program will get you started.

Medicare

Medicare covers services in a skilled nursing facility only for a limited time – up to 100 days – as long as the following criteria are met:

• You’re enrolled in Medicare Part A.
• You were a hospital inpatient for at least three days in a row and you entered a Medicare-certified skilled nursing facility within 30 days of leaving the hospital.
• Your doctor orders skilled nursing care seven days a week or certain skilled therapy services at least five days a week.
• You need care that is deemed medically necessary and can only be provided in a skilled nursing facility.
• Your skilled nursing facility care is for a condition you were treated for while a hospital inpatient, or something else that arose during your hospital stay.
• You have days remaining in your Medicare benefit period. A benefit period starts the day you’re admitted as an inpatient to the hospital and ends when you haven’t been an inpatient in a hospital or skilled nursing facility for 60 days in a row.
• Care is provided in a Medicare-certified SNF.

For more information on skilled nursing costs covered by Medicare, you can download this complete guide.

Medicaid

Medicaid is available to income-qualified seniors. This is a federal program, but it is administered by each state. Here in Georgia, Medicaid covers skilled nursing costs for room, board, and all necessary medical and non-medical goods and services. Care must be provided in a Medicaid-certified nursing home.

While the State of Georgia makes many decisions on what elements of skilled nursing are covered for patients, federal law requires that facilities provide:

• Skilled nursing services
• Rehabilitative care
• Pharmaceutical services
• Medical social services
• Dietary needs
• Other care that is deemed medically necessary

Five Magnolia Manor Campuses are Medicare and Medicaid Certified

Our goal at Magnolia Manor is to help each resident live life to the fullest, no matter what type of care they need. Of our eight communities throughout southern Georgia, Americus, Buena Vista, Columbus, and Midway are Medicare/Medicaid certified. Our skilled nursing residents receive compassionate, professional medical care, while also socializing, participating in activities, receiving spiritual counseling, and enjoying entertainment.

You Are Part of Your Care Team

It is essential that you participate in all activities deemed medically necessary for your recovery. If you refuse some aspects of your skilled nursing care, you could lose Medicare or Medicaid coverage for all your care.

Your skilled nursing facility may also recommend services or therapies that are not covered by Medicare or Medicaid. Whenever new treatments and services are recommended, it’s important to ask whether that service will be covered and if not, to find a suitable replacement that will be covered.

Magnolia Manor helps you live life to the fullest.

As a faith-based, nonprofit organization, Magnolia Manor is committed to the highest values in all our work and ministry as we serve residents of all faiths and backgrounds. We can provide you or your loved one with the exemplary level of care you deserve. Contact us on our website, or at 1-855-540-LIFE (5433) to speak with a friendly member of our team.