Nursing home care is covered by Medicare as long as the nursing home participates in Medicare and Medicaid. If a nursing home doesn’t participate, you’ll have to pay for all of your stay yourself.
Nursing Homes Covered By Medicare
1 Nursing homes are covered by Medicare as long as they follow the rules.
There are two main ways to find a nursing home that accepts Medicare. First, there is a directory on the Medicare website that lists all of the state-approved facilities. You can search by location, size, and care level, among other things. The second way is to ask your doctor or social worker for recommendations on local facilities that provide care at affordable rates.
Once you have narrowed down your options by location and cost, it’s time to consider what kind of nursing home would be best for you and your loved one:
2 Covered nursing home care is limited to a maximum of 100 days per benefit period.
You are eligible for coverage of nursing home care only if your doctor certifies that you need it and has determined that no less restrictive alternative is available to meet your needs.
Once you have been in the nursing home for what amounts to 100 days, your stay will be considered a benefit period and Medicare will not cover further care. However, there is an exception: If you leave the facility early and go back into the hospital as an inpatient, then when examined by a doctor again he/she can find that your condition has worsened such that now more than 100 days of nursing home care would be needed. In this case too much time had passed since being discharged from the last hospital stay before seeking another certification from another physician.
3 Generally, nursing homes must be certified by Medicaid and Medicare to receive the government’s daily payments.
Generally, nursing homes must be certified by Medicaid and Medicare to receive the government’s daily payments. For example, if you have a nursing home stay for rehabilitation services or for long-term care in your own room at a skilled nursing facility, then Medicare covers it.
Medicare also covers hospice care at home or in an assisted living facility. You can go to a home health care agency, but this is not considered part of the same benefit because it doesn’t allow patients to recover from surgery or other illness while they’re there.
4 If a nursing home doesn’t participate in Medicare or Medicaid, you have to pay the entire cost.
If a nursing home doesn’t participate in Medicare or Medicaid, you have to pay the entire cost. You can find out if a nursing home participates by calling their admissions department.
If you want to use either Medicare or Medicaid insurance coverage for your stay at an adult day care center, ask about their financial policies and whether they accept these types of insurance before you sign up for a program.
5 If you go into a nursing home before using up your hospital days, a 100-day benefit period begins.
If you go into a nursing home before using up your hospital days, a 100-day benefit period begins. This means that you can’t use up any of your 100 days in the nursing home. However, if during this time you are admitted to the hospital and then released to a SNF or an acute care setting, those additional days will count toward your Medicare coverage.
As an example, let’s say you’re eligible for 100 total lifetime inpatient days under your Medicare policy. You have used 10 of those days so far: five in an acute care hospital and five more while staying at a SNF. If during day 11 of being at a SNF you are admitted again to an acute care hospital due to an illness or injury (for example), these additional 20 days would be covered by Medicare as long as they were added onto the end of what was left from day 10’s stay at the SNF.”
6 You’re entitled to a new 100-day benefit period if you stay out of the nursing home for 60 days, or for 30 days if you enter a hospital (60 and 30 day periods don’t apply when you’re an inpatient of an SNF).
Medicare will pay for some of your stay, but not all of it. Depending on how long you’ve been in the nursing home and when you last left a nursing facility, Medicare may pay for up to 100 days of care in a nursing home. If you have no other health insurance coverage and leave the nursing home within 30 days after your Medicare coverage starts, Medicare will also pay for up to an additional 60 days (this is called the initial 99-day benefit period). If you’re entitled to both initial 99-day benefit periods and a 100-day benefit period, then Medicare will cover up to 120 days of care in any combination: one or more initial 99-day benefit periods followed by one or more 100-day benefit periods; or two successive 100-day benefit periods separated by less than 31 days during which there was no more than one unpaid spell between them.
If you stay out of the nursing home for 60 consecutive calendar days following either an initial 99 day period of covered care or following receipt of benefits under another Part A plan (for example, skilled nursing facility), then that first 60 day period is called a “grace period.” You can’t receive payment from both plans during this time unless there is joint authorization from both plans for services provided before the expiration date specified on their respective authorizations.
7 Medicare will pay for some of your stay, but not all of it.
Medicare will pay for some of your stay, but not all of it.
Medicare pays for a stay in a nursing home if you meet certain conditions.
If you need long-term care, Medicare is a great option. It provides coverage for nursing home care and other services that can help seniors live independently at home. However, there are limitations to the program’s benefits and certain rules apply. It’s important that you understand these restrictions before enrolling in Medicare Part A or B so you know exactly what benefits are available under each plan type.