Medicare and Nursing Home Care

Long-term Care

Long-term care is not covered under Medicare. This includes long-term care in assisted living facilities, home-based care, and nursing homes. Medicare does cover medical services in these settings. What does this mean? Medicare provides limited coverage for medical services provided in nursing facilities – but does not pay for long-term stays or the cost of “custodial care.”

Short-term Care

Medicare provides coverage for “short-term care” in skilled nursing facilities including nursing homes. Example would be going to a skilled nursing facility such as nursing home for rehabilitation after being treated in a hospital. To qualify, you must first spend at least three days in the hospital to get coverage under Original Medicare.

For costs to be covered under Medicare, you must be formally admitted as an inpatient or currently under “observation status” (must be lying in a hospital bed and attended by hospital staff).

Medicare Part A (hospital insurance) covers institutional care provided in hospitals and skilled nursing facilities. Coverage includes medical services and care given by home health agencies including nursing homes.

Nursing Home Care

Medicare Part A (hospital insurance) covers up to 100 days of skilled care in a Medicare certified nursing home. However, the beneficiary must enter the nursing home within 30 days of being discharged from the hospital. The level of care provided must be highly “skilled” or one that cannot be simply provided on an outpatient basis. The care should also be prescribed by a doctor and delivered under the supervision of a health professional. To be covered, the care must also be delivered daily.

How Much Does Medicare Pay?

Any Medicare beneficiary, people who are 65 or older and those entitled to Social Security benefits are automatically eligible for Medicare Part A (hospital insurance). Those seeking for skilled care in a nursing home and meet the criteria for coverage, are entitled to full payment for the first 20 days of care. However, after the 20th day, the beneficiary is responsible for the daily co-insurance amount up to the 100th day.

There are currently 47 million seniors living in the United States, or 14.5 percent of the population. This number is expected to double over the next 40 years, or around 100 million Americans will be aged 65 years of older by 2060. Which means a growing need for nursing homes and related facilities.

Living in a nursing home can be expensive with costs estimated to be at $83,000 annually. Today, there are 1.3 million seniors living in nursing homes. Most of whom are low-income and initially pay for their care. Over time, this can be a huge drain in their financial resources and eventually turn to Medicaid for coverage.

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