Does Medicare Cover Nursing Home Stays?

June 5, 2013

Many Americans believe that, once they reach age 65, Medicare will provide financially for all of their health care needs. Accordingly, a recent article explains that most elderly Americans are surprised to discover that, in general, Medicare will not cover the vast majority of expenses stemming from long term care in a skilled nursing facility.

 (Photo credit: Wikipedia)

Medicare will only provide coverage for long-term care provided in a skilled nursing facility under certain circumstances. First, the beneficiary must have been admitted to the skilled nursing facility within 30 days of a hospital stay. Additionally, the preceding hospital stay must have been for at least three consecutive days.

Further, the beneficiary’s physician must certify that the care he or she requires can only be provided on an inpatient basis at a skilled nursing facility. Finally, the patient must choose a facility that is approved by the Centers for Medicare and Medicaid Services.

Even if a patient meets the above requirements, Medicare will only cover care for the first 100 days that the patient is in the skilled nursing facility. After the first 100 days, the patient must pay for their care out-of-pocket as long as they are able. Once their financial resources have been significantly depleted they can apply for Medicaid coverage.

 

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