medicare for nursing home coverage

Medicare is often a confusing topic. It’s a government program, so it’s bound by all kinds of rules that can be hard to understand. It’s also a complicated program, with many different parts and pieces you need to know about before you enroll in it. One such part is nursing home coverage under Medicare Part A, which helps pay for long-term care when you can no longer live independently because of illness or disability. This article will help explain what Medicare Part A covers and why you might need coverage through this program

medicare for nursing home coverage

1. What is nursing home coverage?

Medicare Part A, B and D are the main components of Medicare. Part A covers skilled nursing facility care after you’re admitted as an inpatient to a hospital or skilled nursing facility.

Part B covers preventive health services and medical care like doctor’s visits, lab tests and X-rays. You pay 20 percent of the premium for Part B if you don’t have employer-sponsored coverage or another public plan such as Medicaid or TRICARE (the military’s health care program). If you do have other coverage, your premium may be higher than 20 percent depending on your income level.

Part D provides prescription drug coverage for most drugs, including brand names and generic drugs that must be filled at a pharmacy in order to receive benefits under the plan. You’ll pay up to 35 percent of the cost of each drug purchased through Medicare’s open enrollment period unless otherwise noted by your state’s Department of Insurance; this applies even if your drug costs $5 per month just so long as it was purchased during open enrollment period since they’re all calculated together as one big amount when billed later instead of separately priced line items which would increase price per unit over time due to inflation rates being applied evenly across all categories regardless how much each item costs individually so long as they’re grouped together under umbrella term called “Medicare Advantage Plans” which refers specifically only those available through employer sponsored plans versus privately purchased plans offered independently without having been first approved beforehand by employers before signing up customers onto their contracts with insurers who offer these products directly without using intermediaries like administrative assistants who provide assistance programs called “navigators” whose job involves helping consumers understand their options before choosing best option available according . . .

2. Who gets nursing home coverage?

You are eligible for Medicare Part A if you are age 65 or older and have been entitled to Social Security Disability Insurance (SSDI) for 24 months. If you haven’t been entitled to SSDI that long, the period can be waived if your spouse is receiving benefits or has applied for them.

Your spouse may also qualify even if they aren’t yet age 65. As long as they’re eligible, they’ll have their own coverage under Medicare Part A until they reach age 65—after which time they’ll switch to their own coverage under Medicare Part B.

4. How does nursing home coverage work?

Medicare Part A, also known as hospital insurance, covers up to 100 days in a skilled nursing facility (SNF). If you have Medicare Part A and spend more than 20 days in a SNF, Medicare will pay for the first 20 days. You will then be responsible to pay all costs associated with any care after those first 20 days.

Medicare Part B, also known as medical insurance, covers up to 100 days of skilled nursing care per lifetime. It does not cover custodial or long-term care services such as room and board or non-skilled nursing care.

5. When do you qualify for nursing home coverage?

In order for you to qualify for Medicare coverage of nursing home care, you must:

  • Be age 65 or older.
  • Have paid Medicare taxes for at least 10 years. This is called the minimum eligibility period (MEP), and it means that your employer and/or you have been paying Medicare payroll taxes over a period of at least 10 years. You don’t need to actually be retired from work in order to qualify; in fact, most people who become eligible for Medicare during their working years have already paid into the system long enough to meet this requirement.
  • Have a permanent disability and need help with daily activities because of that disability or condition. This can include being unable or unwilling due to illness or injury (even if temporary) as well as having received ongoing treatment in an institution like an LTC facility since being diagnosed with such an illness or injury—including hospice care provided while hospitalized before death occurred if applicable.”

6. How does Medicare Part A work ?

Medicare Part A pays for:

  • Inpatient hospital care, including costs for a semi-private room and meals. If you need care in the intensive care unit (ICU), Medicare will cover it.
  • Skilled nursing facility care, which is medical supervision and rehabilitation services that keep you healthy after surgery or another illness or injury.
  • Hospice care, which provides palliative and supportive services to help manage pain in patients with life-limiting illnesses when cure is no longer possible.
  • Home health care, which are skilled medical services provided in your home by a nurse, physical therapist or other type of health professional who has been certified by Medicare as an eligible provider

7. What is the skill level of care for a nursing home?

There are different types of nursing homes. A skilled nursing facility, or SNF, offers the highest level of care and is licensed to provide long-term skilled nursing care that includes rehabilitative services and therapies, which helps residents recover from illness or injury. An intermediate care facility (ICF), also known as a “personal care” facility (PCF), provides intermediate levels of supervision and assistance with activities such as eating, bathing, dressing and walking around. A resident may need a higher level of treatment than what ICFs can provide so they may move to an extended care facility (ECF). If a person’s disease process is too severe for an ECF but not severe enough for hospitalization or hospice services, they will be placed in a hospice program within their home or other setting approved by Medicare.

8. How are Medicare benefits paid to nursing homes?

Medicare pays for nursing home care based on the average daily cost of care in your area. Once you have spent 100 days in a nursing home, Medicare will begin paying skilled nursing care after an illness or injury that requires you to be there longer. You can also receive short-term rehabilitation services in the nursing home.

Medicare will pay for up to 100 days of care within a one year period at any one Medicare-approved facility, including a long-term acute care hospital (LTACH), psychiatric hospital or nursing facility (NF). A LTACH is used for patients who need specialized medical treatment and require 24/7 intensive monitoring and treatment.

9. What are the limitations of Medicare benefits for nursing homes?

If you have Medicare Part A, you are eligible for four consecutive days of skilled nursing care after a hospital stay that lasts at least three days. These days are free, but after the first four consecutive days of skilled nursing services, you’ll be responsible for paying all costs not covered by Medicare. You’ll also need to pay for custodial or personal care services that aren’t related to your medical treatment or rehabilitation. However, if your doctor determines that it’s medically necessary for you to continue receiving care in a nursing home setting beyond those initial four days, Medicare will cover up to 100 more days (or roughly three months) in a skilled nursing facility before coverage ends.

To find out how much it will cost you out-of-pocket before and after reaching the point where Medicare stops covering your skilled nursing care expenses entirely—and beyond—check out this handy chart from Carington Health:

10. Nursing home coverage under medicare can be a confusing topic.

Medicare is a federal program that provides health insurance benefits to people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

It’s important to note that Medicare is not government-run healthcare. Instead, it’s operated by private companies under contract from the federal government. The Centers for Medicare & Medicaid Services (CMS) manages this program and oversees how it operates across all state lines—and even internationally!


The last thing to consider is that although Medicare covers nursing home care, the amount of coverage you receive is based on your income and assets. If you have too much money in savings or assets, then you may not qualify for all of your nursing home expenses to be covered by Medicare. It’s important to check with an attorney who specializes in elder law before deciding whether to move into a nursing home or not!

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