When a parent or relative needs permanent care, families often face an enormous expense on their own. However, when a person has to be referred to a residence because of their health, the obra social (union or employer health insurance fund) and the private insurer (prepaga) must cover 100% of the cost of the nursing home. It is a right.
If the person holds a Disability Certificate (CUD), coverage must be comprehensive: the residence, care, treatment and every service needed.
If coverage is refused, it can be challenged with a health amparo. The courts have ruled in many cases that coverage must be comprehensive and at 100%. Our team helps you gather the documents and file the claim.
“We defend the right to health and to a dignified old age.”
Who is entitled to it?
People with chronic or degenerative conditions, or with a disability, who need permanent care. For example:
- Older adults who have lost their independence.
- People with a disability who hold a Disability Certificate (CUD).
- Patients with neurological conditions.
- People with chronic or degenerative illnesses.
“PAMI doesn't cover nursing homes”: not so
When a doctor prescribes it and it is the appropriate option, PAMI (the national health program for retirees) must cover long-term residential care or home-based care. Even so, many families are told things like “your income is too high” or “pay for the first few months and we'll reimburse you later.”
The federal courts receive many cases like these: with an amparo (a fast-track court action to protect the right to health) and an interim court order, the judge can order full coverage.
When a doctor prescribes it, PAMI can cover:
- Long-term residential care.
- Home-based care.
- Medication, treatment and medical care.
- Support from specialized staff.
What must be covered?
- The stay in the nursing home.
- Medical and nursing care.
- Meals.
- Therapies and recreational activities.
- Medication.
- Every service needed for comprehensive care.
How we support you
We listen to the family
You tell us about your loved one's situation and the answer you were given.
We gather the medical order
We review the documents that show the need for permanent care.
Formal demand and amparo
We send a formal demand to the health fund, insurer or PAMI and, if they don't comply, we file an *amparo* with an interim court order.
Ongoing support
We follow the case and keep you informed of every step forward.
Useful documents
- ID (DNI) and membership card for the health fund, insurer or PAMI.
- Medical order for residential care or permanent care.
- Medical records.
- Disability Certificate (CUD), if they have one.
- The refusal or the answer you received.
- A quote or invoices from the nursing home, if your loved one is already there.
Don’t worry if you don’t have everything: we will go through it together at the consultation.
Frequently asked questions
Does a private insurer have to pay 100% of the nursing home?
When a person needs to be referred to a residence because of their health and requires permanent care, the obra social (union or employer health insurance fund) and the private insurer (prepaga) must cover 100% of the cost. If they refuse, you can challenge it with a health amparo.
I was told it isn't covered “because of our income.” Is that right?
It is one of the answers families hear most often. When a doctor prescribes residential care and it is the appropriate option, the right to coverage does not depend on that answer. Talk to us before agreeing to pay.
We are already paying for the nursing home. Can we still make a claim?
Yes, you can still claim the coverage. Keep the invoices and receipts: they are important for the claim.
What changes if the person has a Disability Certificate?
With a CUD, coverage must be comprehensive: it includes the residence, care, treatment and every service needed.
Related topics
General information only. It is not a substitute for advice on your specific case.