Does Medicare cover nursing home care?

The Social Security Act provides Medicare coverage for necessary post-hospital extended care services for up to 100 days. Extended care services are defined as nursing care and rehabilitation therapy provided to a Medicare patient at a skilled nursing facility. In determining whether this significant, yet temporary, benefit is available, the following basic requirements must be satisfied:

1. Only post-hospital admissions meeting the “three day hospital stay” requirement are covered;

2. In most cases, post-hospital transfer and skilled services must begin within 30 days after leaving the hospital;

3. Only skilled nursing or rehabilitation care is covered;

4. The skilled services must be provided on a “daily” basis; and

5. No more than 100 days per “spell of illness” may be covered.

For a detailed explanation of the Medicare skilled nursing facility benefit and requirements, ask for a free copy of our white paper, Understanding the Medicare Skilled Nursing Facility Benefit.

In 2014, Part A (Original/Traditional) Medicare beneficiaries in skilled nursing facilities pay:

$0 for days 1-20 in a benefit period;
$152 per day for days 21-100 in a benefit period; and
All costs for each day after day 100 in the benefit period.

Part C (Advantage/Replacement) Medicare beneficiaries pay a skilled nursing facility co-payment based on the coverage offered through their health plan. For instance, in 2014, the AARP MedicareComplete SecureHorizons (HMO) plan requires the Medicare beneficiary to pay $150 for days 1-5 and $0 per day for days 6-90. To find co-payment information concerning other Medicare Advantage plans, go to http://www.medicare.gov/find-a-plan/questions/search-by-plan-name-or-plan-id.aspx.

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