How Long Does Medicare Really Pay for a Nursing Home?
Jesica L. ThorsonJesica L. ThorsonOriginal Medicare will cover a short-term stay in a skilled nursing facility under specific conditions.
Medicare Part A covered a limited stay after a qualifying hospital stay of at least three days. This coverage includes room and board at the skilled nursing facility as well as physical therapy, occupational therapy, medications, and other necessary treatments.
Original Medicare will cover the full cost from days 1 – 20. Medicare will require a daily copayment from days 21- 100. This copay is $217 per day. Medicare coverage stops after 100 days.
It should be noted that the Medicare coverage only lasts so long the patient needs skilled medical services. The patient’s physician will determine if skilled nursing care is necessary to maintain or improve their condition or to prevent or delay the condition from getting worse. It is possible that the coverage will not last 100 days if it is not medically necessary.
It should also be noted that Medicare Advantage plans will sometimes waive the three-day hospital stay requirement. However, some plans do charge copays during the first 20 days, and not all skilled nursing facilities may accept your plan.
Once Medicare days have ended the patient will need to determine if it is suitable for them to return home. If they are unable to return home, then they will need to determine a different pay source for their stay at the skilled nursing facility. An elder law attorney can help determine how best to cover these expenses through Medicaid, Veterans benefits or private pay.
