Medicare has limited coverage for nursing home care, and even if you qualify, they will only help pay for a short stay. If you find yourself in need of nursing home care, it will help to know how many days will Medicare pay for a nursing home stay?
How Many Days of Medicare Nursing Home Coverage Do You Have?
Original Medicare will pay a portion of your costs to receive skilled nursing care at a qualifying facility for a few days. The amount Medicare covers will vary by the number of days you need the services, within a benefit period. Medicare pays:
- All of your costs of skilled nursing care for the first 20 days of each benefit period.
- All but $167.50 per day for Days 21 – 100 per benefit period. You must pay the coinsurance amount of $167.50 a day for these days.
- After Day 100 of care within each benefit period, Medicare pays nothing for your skilled nursing care. You must bear these costs yourself.
What Are the Requirements for Medicare Coverage of Nursing Home Care?
Medicare makes you jump through multiple hoops to get any benefits for staying in a qualifying nursing facility. These requirements include:
- You have Part A coverage.
- You have not used all of your allotted days in your benefit period.
- You had a qualifying hospital stay (three or more days inpatient at a hospital).
- Your doctor certifies that you need daily skilled nursing care.
- You use a Medicare-approved skilled nursing facility.
- Your medical condition is hospital-related.
Medicare and Standard Nursing Home Care
If you need only custodial care, Medicare will not help pay anything for your stay in a nursing home. Custodial care is when people need help with activities of daily living, such as bathing, dressing, and eating. Medicare will only pay, if you need skilled nursing care, like changing sterile dressings. If Medicare determines that it is not medically necessary for you to have help with your care, they will not pay for it.
What is a Certified Skilled Nursing Facility?
Even if you satisfy the requirement that your skilled nursing care is medically necessary, Medicare will only pay for your brief stay at a skilled nursing facility (SNF) that meets Medicare’s certification process. If the place where you receive your care is not a certified SNF, Medicare will not pay.
What Does Medicare Cover at an SNF?
For the short time Medicare allows you to stay at an SNF, they will help pay for these services:
- A semi-private room (shared with at least one other patient)
- Skilled nursing care
- Services to meet the approved health goal of your stay at the SNF, which might include physical therapy, occupational therapy, and speech-language pathology services.
- The supplies and equipment used for your care while you were an inpatient in the SNF.
What is a Benefit Period?
Medicare starts the clock over on your SNF coverage for each benefit period, and you have an unlimited number of benefit periods. The day you become an inpatient at a hospital or SNF, a new benefit period begins. It ends when you go for 60 days in a row, receiving no inpatient hospital care or SNF care.
This article discusses the general law, and your state might have different regulations. Talk with an elder law attorney in your area.
Centers for Medicare & Medicaid Services. “Medicare Part A coverage – nursing home care.” (accessed June 14, 2018) https://www.medicare.gov/what-medicare-covers/part-a/part-a-coverage-nursing-home-care.html