Does Medicare pay for nursing home care?


Q: Does Medicare or Medicaid pay for nursing home care?

A: Medicare pays for skilled care in a facility if:

  1. The beneficiary is first hospitalized for at least 3 days
    2. The beneficiary then enters a Medicare approved facility
    3. For the same condition for which they were hospitalized
    4. Within 30 days of discharge.

If these conditions are met Medicare will pay:
1. The full Medicare approved charge for the first 20 days.
2. All but approximately $137 per day for the next 80 days (in 2010 - check the website for the most up-to-date numbers).
3. The additional charges are typically covered by Medicare supplements.

The skilled nursing benefit is per benefit period – not annual. A benefit period is described as periods of care separated by at least 60 days.

The Medicare beneficiary may be denied skilled nursing benefits even if they have benefit days left. This is because of the definition of skilled care. The patient must be receiving physician ordered and professionally rendered medically related services and must be making progress. Once progress ceases then the patient is no longer eligible for skilled services and hence, no longer eligible for Medicare skilled nursing benefits.

At this point, the person would apply for Medicaid if continued skilled, intermediate, or custodial care was required in a facility.

Ralph S. Robbins, CFP©, is a licensed Certified Financial Planning Practitioner and an Accredited VA Claims Agent specializing in Eldercare Financial Planning. He works everyday helping families in crisis find creative ways to fund long-term care expenses and deal with family financial issues.

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My mother was admitted to a nursing home after leaving the hospital after several days. She was unable to walk or even sit up because of severe pain , but the hospital never gave her an actual diagnoses. She ended up paying for the nursing home with her own money because she was never diagnosed in the ER or during her hospital stay.