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Medicare and Nursing Home Care

     Many seniors mistakenly believe that Medicare covers nursing home stays. In fact, Medicare’s coverage for nursing home care is quite limited. Medicare only provides up to 100 days of “skilled nursing care” per illness, and there are a number of requirements that must be met before the nursing home stay will be covered.

     In order for a nursing home stay to be covered by Medicare, the individual must enter a Medicare approved “skilled nursing facility” or nursing home within 30 days of a hospital stay.  The hospital stay must have lasted at least three days, not including the date of discharge. The care in the nursing home must be for the same condition as the hospital stay. In addition, the individual must need “skilled care.” This means a physician must order the treatment, and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse. Finally, Medicare only covers “acute” care as opposed to custodial care. This means that Medicare only covers care for individuals who are likely to recover from their medical conditions, not care for individuals who only need assistance with activities of daily living, including: eating, bathing, continence, dressing, toileting, and transferring.

     Once the individual is in a nursing facility, Medicare will cover the cost of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies.  For the first 20 days, Medicare covers 100 percent of the costs.  Beginning on day 21, the individual is responsible for a daily co-payment amount.  This daily copayment amount may be covered by the individual’s Medicare supplemental insurance policy, assuming he or she already has one.  After the 100 days are up, Medicare nursing home benefits end, and the individual is then responsible for all costs moving forward.  At that point, many individuals will turn to Medicaid for assistance.

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