Does Medicare pay for assisted living in Tennessee?
No. Medicare never pays for room, board or personal care in a Tennessee assisted-care living facility, though it does pay for covered medical services a resident receives there, such as doctor visits, home health visits after a hospital stay, therapy and hospice.
Tennessee's ACLF rule requires Medicare-reimbursable services to be provided by a Medicare-certified provider (0720-26-.07(4)), so the home health agency or hospice that bills Medicare must be certified even when it serves a resident inside the building.
How long does Medicare pay for a nursing home after a Memphis hospital stay?
Medicare Part A can cover up to 100 days of skilled nursing facility care per benefit period after a qualifying inpatient hospital stay of at least three days, when daily skilled nursing or therapy is needed; days 1-20 have no coinsurance and days 21-100 have a daily coinsurance amount.
Coverage ends when the patient no longer needs daily skilled care, which is often well before day 100. Time spent “under observation” in the hospital does not count toward the three inpatient days, so ask the hospital case manager at Methodist, Baptist, Saint Francis or Regional One whether your parent is formally admitted. Medicare Advantage plans set their own rules and often require prior authorization for a skilled nursing stay.
Does Medicare pay for home care in Memphis?
Medicare pays for intermittent skilled home health care, such as nursing visits, physical therapy and some aide visits, for homebound patients under a doctor's plan of care, but it does not pay for ongoing hourly help with bathing, meals or supervision.
That non-medical help is what most families mean by “home care,” and it is paid privately, by long-term care insurance, through TennCare CHOICES, OPTIONS, or by VA benefits. HFC licenses home health agencies; our roster lists those with offices in Shelby, Fayette and Tipton counties.
Who helps Memphis seniors compare Medicare plans for free?
TN SHIP, the State Health Insurance Assistance Program run by the Tennessee Department of Disability and Aging, gives free, unbiased Medicare counseling; call 1-877-801-0044.
SHIP counselors compare Medicare Advantage, Part D drug plans and supplements, and help with Medicare Savings Programs and Extra Help applications. Medicare's own help line is 1-800-MEDICARE.
At a glance
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Skilled nursing | Up to 100 days after a qualifying inpatient stay | Long-term custodial nursing home care |
| Home health | Intermittent skilled visits for homebound patients | Hourly non-medical home care |
| Hospice | The hospice team, drugs and equipment for the terminal illness | Room and board in a facility |
| Assisted living | Medical services delivered there | Rent, meals or personal care |
Sources include Tenn. Comp. R. & Regs. chapters 0720-26, 0720-21 and 0720-18, Health Facilities Commission and TennCare pages, CareScout and VA rate tables as cited above; see our editorial standards.
