Medicare Coverage for Religious Nonmedical Health Care Institutions (RNHCI)

If you qualify under Medicare for hospital or skilled nursing facility care, Medicare Part A hospital insurance will cover nonreligious and nonmedical items and services only. These are typically items and services that do not require a doctor’s order or a prescription such as a nonprivate room, your meals, unmedicated wound dressings and a basic walker.

Medicare requires you and the facility to meet three specific conditions before it will cover your care in an RNHCI.

You are responsible for your Medicare Part A deductible for each benefit period and coinsurance if your stay is longer than 60 days in each benefit period. A benefit period begins when you are admitted to a hospital, skilled nursing facility or RNHCI and continues for 60 consecutive days after you are discharged.

You may also have to pay out of pocket for a private room unless it’s medically necessary. And you may be responsible for the costs of private-duty nursing or the use of a telephone or television in your room.

Not all care provided by an RNHCI may be covered by Medicare. The institution’s utilization review committee will assess your needs from time to time to determine whether your level of care is eligible for Medicare coverage.

A Medigap — Medicare Supplement insurance — policy can help you cover the costs of your deductible and coinsurance.

A Medicare Advantage — Medicare Part C — plan may also provide you with benefits not included in Original Medicare.

Both Medigap and Medicare Advantage plans are sold by private insurers, and benefits vary from plan to plan. You should check with your plan’s administrator to determine exactly what’s covered.

All Medicare beneficiaries are required to sign an election form when they choose to receive care from an RNHCI. This is a federal government form confirming that you are choosing an RNHCI and that your religious beliefs are such that you do not want to receive conventional or unconventional medical treatment.

The form is submitted to Medicare only if you need a Medicare-covered level of care — meaning the level of care provided by a hospital or skilled nursing facility.

Even if you elect to receive care through a religious nonmedical health care institution, you will always be able to get medically necessary Medicare Part A services if you choose.

Medically necessary services include any items, supplies or services that meet accepted standards of medicine and are needed to diagnose or treat your illness, injury, condition, disease or symptoms.

When making your election for RNHCI care with Medicare, you must agree that if you decide to accept standard medical care, you will revoke your election. If that happens, you must wait a full year after the first revocation to apply for RNHCI care in the future. You’ll also have to wait five years if you revoke any future elections to receive RNHCI care.