Different Types of Nursing Care and Your Medicare Coverage
This article was updated on: 09/10/2018
Nursing care is an important part of your medical care, whether you are seen in a doctor’s office, urgent care or outpatient center, hospital, skilled nursing facility, or even your home. Here’s a look at the different types of nursing care and how Medicare pays for each.
What are the different types of nursing care I might receive?
According to the American Nurses Association (ANA), there are three main types of professionals who provide nursing care: licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs).
- Licensed practical nurses, also called licensed vocational nurses (LVNs) in Texas and California, are health professionals who are trained to provide basic health care services, such as changing bandages or taking vital signs, under the supervision of a doctor or registered nurse, according to the Bureau of Labor Statistics. They must be licensed by the state to practice. Most LPNs complete a one-year education program in nursing care.
- Registered nurses must have either a two-year associate degree in nursing (ADN) or a four-year bachelor’s of science in nursing (BSN) in order to take the state board exam, and must be licensed by the state, according to the American Nurses Association. RNs can do physical exams, provide counseling and education, and work with other health professionals to coordinate patient care. They can do more specialized treatments and interventions, and interpret patient information to make decisions about care. They can also administer medications and conduct wound care.
- Advanced practice RNs have completed additional education to at least a master’s degree level and they provide the most specialized types of nursing care, according to the ANA. They can be nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists. They are able to diagnose and treat common illnesses and injuries and prescribe medications.
In many settings, you may also receive basic nursing care from a nursing assistant, sometimes called a nursing aid (NA). According to the Bureau of Labor Statistics, NAs take vital signs, help patients bathe and dress, and turn and reposition patients. Although they are not technically nurses, they must complete an approved education program and pass a state competency test. They are supervised by licensed vocational nurses and registered nurses.
How does Medicare cover the different types of nursing care?
If you get nursing care in a doctor’s office or outpatient setting, under Original Medicare (Part A and Part B), those services are generally covered under Part B and are typically included in the cost of the office visit or other outpatient service you receive.
During a covered stay in an inpatient setting, such as a hospital, rehabilitation center, or skilled nursing facility, nursing care is covered under Part A and is typically included in your bill for the stay.
You may be responsible for deductibles, copayments, and/or coinsurance amounts.
Does Medicare cover different types of nursing care at home?
Original Medicare does generally cover home nursing care services if the following conditions are met:
- Your doctor certifies that you need intermittent skilled nursing care.
- The home health agency you use is Medicare certified.
- Your doctor certifies you are homebound because you either are unable to leave your home without help or leaving home isn’t recommended because of your health condition.
If all of these things are true, Medicare will generally cover part-time or intermittent nursing care provided by an RN or LPN in your home. In most cases, you pay nothing for home health nursing care under Original Medicare. Note that Medicare does not cover 24-hour home care or personal care provided by a nursing assistant if that is the only type of care you need.
Does Medicare pay for nursing care in a skilled nursing facility or rehab center?
Part A pays for skilled nursing facility (SNF) care if you have Part A, have days left in your benefit period, and you meet the eligibility requirements:
- You had a qualifying hospital stay of at least three days.
- You need skilled nursing care to either improve your current condition or prevent it from getting worse. Custodial care, such as help with bathing, dressing, and eating, is not considered skilled nursing care and is typically not covered under Medicare.
- The SNF is certified by Medicare.
- You need the skilled nursing care because of the condition that required the qualifying hospital stay, or one you developed while you were in the hospital during a covered stay.
You can get up to 100 days of skilled nursing care during a benefit period if your stay is eligible under Medicare guidelines. For days 101 and beyond you pay all costs. Deductible, copayment, and/or coinsurance amounts may apply.
Does Medicare cover nursing care if I choose hospice care?
Hospice care, including the different types of nursing care you may need, is typically covered under Part A. In most cases, you pay nothing for nursing care under your hospice benefit.
Keep in mind that the coverage guidelines above apply only to Original Medicare (Part A and Part B). If you get your Medicare benefits through a Medicare Advantage plan, your plan may have different guidelines and payment policies. Medicare Advantage plans are required by law to cover everything that Original Medicare covers (except for hospice care, which is still covered under Part A), but they may offer additional benefits that apply to home health or skilled nursing care. Check your plan documents to see how the different types of nursing care are covered under your plan.
Need more information on Medicare coverage for the different types of nursing care?
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