What Does Medicare Pay For In A Nursing Home?

Do you or a loved one have Medicare and need the services of a nursing home? Are you wondering just what Medicare will pay for? It is all explained here.

Some people say Medicare does not cover the cost of a nursing home stay. Is this true?

Yes and no. For the most part “custodial” care is not covered. Custodial care is help with activities such as bathing, dressing, eating, getting in and out of bed (daily living). This kind of care is usually the patient’s own responsibility. If you have long-term care insurance that WILL cover it and if you also receive Medicaid you may qualify for payment.
The only exception to this rule is that Medicare does sometimes cover a temporary stay in a nursing home or rehabilitation facility in some circumstances.

So what are these “circumstances”?

First, you must have Medicare Part A (hospital insurance). You must be going directly from a hospital stay of at least three days. Your doctor must also state that you need the services of the facility as a result of the hospital stay. In other words, the illness or injury you were in the hospital for is what you need the rehabilitation or skilled care for. This can include things like physical therapy or intravenous medication. The main thing is that the services ordered can only be provided if you are an inpatient at a Medicare certified facility.

What does it cover exactly?

Medicare will pay for 100 days. This includes prescription drugs, semi-private room, “custodial” care, nursing and medical services.

What does it cost me exactly?

For up to the first 20 days Medicare covers 100% of the cost. For days 21 to 100, you have a daily co-payment that is about $130.00 a day and Medicare will pay the rest over that. After 100 days you pay the full cost — Medicare pays nothing.

Related posts

1. What is Medicare Part A?
2. Can My Medicare Benefits Run Out?
3. What is a Benefit Period for Medicare?
4. WHAT MEDICARE PLAN A COVERS
5. Does Medicare Supplemental Insurance Cover My Hospital Stay?

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