Nursing Home Coverage When Care Is Needed
Q: What accommodations are covered in nursing homes?
A: Under the Active Plan, coverage includes private room accommodations in nursing homes in Canada when care is required for acute, convalescent, or palliative treatment. The government-authorized co-payment is also covered in these situations. Long-term or custodial care is not included.
Tom had always been proactive about his health benefits, but he’d never really looked into the fine print around nursing home coverage—until he found himself recovering from surgery after a sudden illness.
Following a three-day hospital stay, Tom’s doctor recommended a short-term admission to a nursing home for convalescent care, where he could receive rehabilitation and monitoring before returning home. Unsure whether this would be covered, Tom reviewed his Active Plan and spoke with AGA Benefit Solutions.
He was relieved to learn that his nursing home stay was covered—because it qualified as convalescent care, following an acute hospital stay. His private room and board, along with the government-authorized co-payment, were included under his benefits as long as the facility was located in Canada and the treatment met the defined criteria.
This experience was eye-opening for Tom. He realized the Active Plan supports members who need short-term nursing home care for acute, convalescent, or palliative treatment, but it doesn’t extend to long-term or custodial care. It also doesn’t apply to care for family members like parents.
For Tom, knowing that this kind of medically necessary care was covered gave him confidence during a vulnerable time—and helped him focus on his recovery without worrying about the cost.