Omaha Senior AdvisorDoes Medicare pay for assisted living in Nebraska?
No. Medicare does not pay for room, board or personal care in an assisted living facility in Nebraska or any other state; it continues to pay for a resident's doctor visits, prescriptions under Part D, home health visits and hospice while the resident lives there.
That is why the payment options for Omaha assisted living are private funds, long-term care insurance, VA pension benefits and, for eligible residents in certified buildings, the Medicaid AD Waiver for services. A Medicare Advantage plan may offer small supplemental benefits, but none pays monthly assisted living rent.
When does Medicare pay for a nursing home stay?
Original Medicare pays for skilled nursing facility care after a qualifying inpatient hospital stay of at least three days, when the patient needs daily skilled nursing or therapy for a condition treated in the hospital; it pays in full for the first 20 days and covers days 21 through 100 with a daily coinsurance, and nothing after day 100.
Observation days in the hospital do not count toward the three days, so ask the hospital whether your parent is formally admitted. Medicare stops paying sooner if the patient no longer needs daily skilled care. Long-term custodial care, help with bathing, dressing and eating without a skilled need, is never a Medicare benefit; in a nursing home it is paid privately or by Nebraska Medicaid.
What does Medicare pay for at home?
Medicare pays for home health care, part-time skilled nursing, therapy and home health aide visits, for a homebound patient under a doctor's plan of care, at no cost to the patient when the agency is Medicare-certified; it does not pay for hourly or round-the-clock caregivers when that is the only care needed.
CMS's home health dataset lists 27 Medicare-certified home health agencies with offices in the five counties, and its hospice dataset lists 15 certified hospices; many serve ZIP codes well beyond their office address. Ask the hospital case manager or doctor which agencies they refer to, and ask the agency how soon the first nursing visit can happen after discharge. Medicare also covers durable medical equipment such as walkers and hospital beds when a doctor orders them.
How does Medicare's hospice benefit work in Omaha?
Medicare's hospice benefit covers a comfort-care team, medications for the terminal illness, equipment and supplies for a patient whose doctor certifies a life expectancy of six months or less, delivered wherever the patient lives, including at home, in an ALF or in a nursing home; it does not pay room and board.
CMS lists 15 Medicare-certified hospices with offices in the five Omaha-area counties, including CHI Health at Home - Omaha, St. Joseph Villa Homecare & Hospice, Endless Journey, LLC, Aseracare Hospice. A patient can leave hospice and return to curative treatment at any time. In a Nebraska ALF, a hospice is one of the outside providers that can deliver complex care so the resident can stay.
How is Medicare Advantage different for Omaha seniors?
Medicare Advantage plans must cover everything Original Medicare covers, including skilled nursing facility care, home health and hospice, but they set their own rules: many require prior authorization, use provider networks and may waive the three-day hospital stay requirement.
Before a planned discharge to rehab, ask the plan which skilled nursing facilities are in network and whether authorization has been granted. Free, unbiased Medicare counseling is available from the Nebraska Senior Health Insurance Information Program (SHIIP) and through ENOA's Information and Assistance line.
At a glance
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Nursing homes | Up to 100 days of skilled care after a qualifying stay | Long-term custodial care |
| Assisted living | Doctor visits and home health while living there | Rent, meals or personal care |
| At home | Part-time skilled home health | Hourly or 24-hour caregivers |
| Hospice | Team, drugs and equipment | Room and board |
Sources include 175 NAC 4 (assisted-living facilities), the Nebraska Revised Statutes cited above, Nebraska DHHS program and licensure pages, CMS, CareScout and VA rate tables; see our editorial standards.
