What Does Medicare-Certified Mean for a Continuing Care Retirement Community?

A source of confusion for many prospective CCRC residents is the difference between a “Medicare-certified” community and a “private-pay” community. Simply put, a community that chooses to be Medicare-certified has met the federal minimum requirements for patient care and management- pertaining to the on-site health care facility- including administration, clinical services, standards of excellence, and more.

Medicare certification is only applicable to skilled nursing facilities (SNFs), which are licensed in their respective state to offer 24-hour medical care provided by a registered nurse or rehabilitative staff, including procedures such as IV and drug administration, wound care, lab tests, physical therapy, and more. Medicare certification or lack thereof, has no bearing on the independent living or assisted living phases of the CCRC.

Contrary to what many believe Medicare does not cover non-medical, assisted living services if that is the only type of care needed. (Long-term care insurance is specifically designed to cover these expenses.) However, on a limited basis, Medicare [Part A] may cover the cost of skilled care provided by a Medicare-certified.

Generally speaking, your care must be preceded by a 3-day minimum hospital stay and the full cost is only covered for the first 20 days of care or rehab. Between 21 and 100 days Medicare could pay up to $152 per day (2014). After 100 days Medicare ceases to provide coverage. Additionally, any coverage provided applies only to a “semi-private” room. The 100 day period for Medicare can reset under certain conditions.