Different Types of Nursing and Your Medicare Coverage

Whether you’re in a doctor’s office, the hospital, or a rehabilitation facility, you will likely receive nursing care. Nurses provide many different types of care and work in a variety of medical settings. It’s helpful to know what patient care nurses provide. A patient can receive different levels of care depending on the nurse’s license and training. If you have Medicare coverage, most of your care will mainly be what is called Medicare skilled nursing.

What are the Different Types of Nursing Care?
Just like most professions, nurses have special training that teaches them how to care for patients. There are levels of training, college degrees, and licenses that nurses must receive in order to practice. And like different kinds of doctors, nurses sometimes have a specialized field. Below is an overview of the levels of training, licenses, and care they provide.

Licensed Practical Nurse (LPN): An LPN is a nurse who works under the supervision of registered nurses and doctors. LPNs often assist the registered nurses. They must complete a one year training program, which is often through vocational schools and community colleges. The nurses then have to take a test to be licensed by the state.

LPN’s take your blood pressure and other vital signs, give shots, collect samples like blood for testing, and provide general bedside care. LPNs spend time with patients and assist with daily care, including bathing and dressing. They work closely with registered nurses and other care providers. LPNs also work in many different settings, including doctor’s offices, skilled nursing facilities, and home health care.

Registered Nurse (RN): An RN must complete training either in a four-year bachelor’s degree college program, a two-year associate’s degree program, or graduate from a nursing program. They must pass a state licensing exam before they can treat patients.

RNs work in many settings. Because they have a higher level of training than an LPN, they are able to care for patients without direct supervision in more situations than LPNs. They will monitor your medications, start and check IVs, and perform many other medical procedures, but a doctor must “sign off” to show that he is overseeing the patient’s care. Many RNs will specialize in one area, like helping doctors deliver babies.

Nursing and Medicare Coverage
When you look at what your Medicare insurance covers, you’ll often see the words, “skilled nursing.” This is a term that is used to describe the level of nursing care that your Medicare insurance will pay for. Most often, you’ll see it when they talk about “skilled nursing facilities.” This is where patients receive skilled nursing services under the different parts of Medicare. Only registered nurses are considered “skilled nursing.”

Medicare Part A

Inpatient. As you may know, Part A of your Medicare coverage (if you have Original Medicare) pays for most of your care when you are hospitalized. Coverage includes care that you receive from hospital nursing staff, as long as they are registered nurses.Rehabilitation. Part A also pays for most of your care while in a “skilled nursing facility.” This is a rehabilitation facility that you attend if you need additional recovery care after your hospital stay. The nurses will ensure that you receive your medications, care for your wound if you’ve had surgery or an injury, and communicate with other medical staff, especially your doctor.

Note: A skilled nursing or rehab facility is sometimes also called a “nursing home.” The care you receive in a nursing home or skilled nursing facility that isn’t solely to continue recovering after a hospital stay is not usually covered by Medicare.

Home Health Care Services. When you return home either from your hospital stay or rehab, you can receive home health services. Under a doctor’s care, you will receive skilled nursing care by nurses who come to your home to monitor your recovery. These nurses work through a Medicare-certified home health agency. They will make sure that you take your medications and are healing properly.Hospice Care. If you are terminally ill and you, your family, and your doctor have decided to stop treatment and need palliative (comfort) care, you will receive most of these services through Medicare coverage. Typically, you will receive your care at home. Nurses will make home visits to administer pain medications and monitor your condition.

The Role of Skilled Nursing in Your Care
Nurses are key players to help you recover from illness, surgery, injury, or make your end-of-life more comfortable when you choose hospice care. Of all the members of your health care provider “team,” you will probably have the most contact with nurses. And since they communicate information about your recovery to doctors and other necessary people, it’s important to talk to them about any problems you might be having. Don’t be afraid to ask questions if you don’t understand something about a medicine or your care. If the nurse doesn’t know the answer, she will find out or ask the doctor.

Note: The information here is for Original Medicare coverage; if you have a Medicare Advantage plan and/or a Medigap plan, different care may be covered. Please refer to your printed plan information or look online at www.medicare.gov.

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