Does Medicare Cover Care in Religious, Nonmedical Health-Care Institutions?
This article was updated on: 09/10/2018
What is a religious nonmedical health-care institution?
A religious nonmedical health-care institution is a facility that provides nonmedical nursing items and services to people who need hospital or skilled nursing facility care but who choose to rely solely upon a religious method of healing. These people may feel that the acceptance of medical services would be inconsistent with their religious beliefs.
Religious nonmedical health-care institutions supply nonmedical items and services through nonmedical nursing personnel. These nursing personnel are experienced in caring for the physical needs of nonmedical patients. Nonmedical services include assistance with activities of daily living (such as bathing and eating), assistance walking, nutritional needs, and comfort measures according to the Centers for Medicare & Medicaid Services.
Will Medicare cover services received from a religious, nonmedical health-care institution?
If you are admitted to a religious, nonmedical health-care institution, Medicare Part A (hospital insurance) covers only inpatient nonreligious, nonmedical items and services. According to Medicare’s coverage policy, non-medical items and services include room and board, and any items or services that don’t require a doctor’s order or prescription, like nonmedicated wound dressings or use of a standard walker.
In order to receive coverage from the Medicare inpatient religious, nonmedical health-care institution benefit, your care must meet the following conditions:
- The religious, nonmedical health-care institution must be certified to participate in Medicare
- The religious, nonmedical health-care institution’s Utilization Review Committee must agree that you would require inpatient hospital or skilled nursing facility care if you were not in a religious, nonmedical health-care institution
- You must have a valid election form indicating your choice to receive nonmedical care or treatment for religious reasons on record with Medicare.
You are responsible for paying the Medicare Part A deductible, coinsurance and copayment for inpatient nonmedical health-care you receive during your stay. In 2018, for each benefit period you pay:
- Days 1–60: $1,340 deductible ($0 coinsurance)
- Days 61–90: $335 coinsurance each day
- Days 91– and beyond: $670 coinsurance each day per each lifetime reserve day, up to 60 days in your lifetime
- Each day beyond 150 days: all costs.
You are also responsible for the cost of religious items and services from a religious practitioner, which are not covered by Medicare.
Medicare may cover the nonmedical care a religious, nonmedical health-care institution provides you in your home if the conditions of coverage are met. Medicare covered services may include:
- Intermittent home health-care if you are confined to your home for health reasons (Medicare requires a brief letter of intent from the provider),
- Certain durable medical equipment that does not require a doctor’s order, such as standard walkers, crutches, commodes, and hospital beds.
Similar to the inpatient benefit for religious nonmedical health-care institutions, Medicare will pay for nonmedical services in the home. Medicare will not cover the cost of religious items or services provided by the institution.
What is an election to receive care from a religious nonmedical health-care institution?
An election is a written statement signed and notarized by a Medicare beneficiary or the beneficiary’s legal representative. This written statement usually indicates the beneficiary’s choice to receive nonmedical care for religious reasons. The election form must be submitted to the Centers for Medicare & Medicaid Services (CMS) prior to receiving nonmedical items or services from a religious nonmedical health-care institution. You can revoke an election at any time. Your election will be cancelled by either one of two methods:
- By submitting a written statement to CMS indicating your desire to cancel the election; or
- By filing a claim for nonexcepted medical treatment
Note: Medical care you receive involuntarily (such as emergency treatment you receive when you are unconscious) or which is required under federal, state, or local laws (such as certain immunizations) are exceptions that do not cancel your election. Medicare may pay for this treatment as medically necessary covered services.
If you revoke your election to receive care from a religious nonmedical health-care institution, you may reinstate it later by signing another written election form. If you revoke your second election, you must wait one year before Medicare coverage is available if you sign a third election form. Medicare will not pay for care at a religious nonmedical health-care institution for a period of five years following your third (or subsequent) revocation of an election.
Do you have other coverage questions about Medicare’s religious nonmedical health-care institution benefits? I am here to help you understand your Medicare benefits or evaluate your Medicare coverage options.
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