What does Medicare Pay for in a Nursing Home?

Does Medicare Pay For Nursing Home Care?


There is a common misconception that Medicare pays all the costs of nursing home stays. In fact, Medicare covers skilled care in a nursing facility under certain very strict conditions for a limited time. For example, to qualify, your doctor must have ordered daily skilled care.

If you qualify for Medicare, you pay the amounts below for each benefit period following at least a 3-day covered hospital stay:

Days 1-20: $0 for each day.

Days 21-100: $133.50 for each day.

Days over 100: 100 percent of the cost.

Medicaid takes over after personal savings and assets are exhausted.

Source: www.medicare.gov


Medicare: (800) 633-4227

Who Determines the Length of Stay at a Skilled Nursing and Rehab Center?

When determining how long a patient will be staying after a healthcare setback at a skilled nursing and rehab center, a few points should be covered.

Families need to be aware the patient must be receiving physician ordered and professionally receiving  medically related services.

The patient must show indication of making progress during the stay in order for Medicare to warrant the time at skilled nursing and rehab facility.  Progress can be measured during physical and/or occupational therapy.  Once progress ceases then the patient is no longer eligible for skilled services under Medicare.
At this point, the person would apply for Medicaid if continued skilled, intermediate, or custodial care was required in a facility. Be sure to check with the social worker at the skilled nursing and rehab facility should you need to discuss progress and eligibility.

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