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.
Other Frequently Asked Questions
- Can a family member be paid for services provided to the Medicaid applicant?
- Can I gift or transfer assets for less than fair value and receive Medicaid nursing home benefits?
- Does Medicare cover nursing home care?
- How is medical necessity determined for Medicaid nursing home care?
- How is the Medicaid applicant’s home protected against the Medicaid Estate Recovery Program (MERP)?
- How much is the Medicaid copayment to the nursing home?
- I thought you could gift a certain amount each year without penalty?
- What are some strategies to getting under the Medicaid resource limit?
- What are the basic eligibility requirements for long-term care Medicaid in Texas?
- What do Medicaid nursing home benefits cover?
- What if medical necessity is denied?
- What is a Medicaid transfer penalty and how is the penalty calculated?
- What is a Qualified Income Trust (QIT)?
- What resources are excluded for purposes of determining Medicaid eligibility?