Q & A: Medicare & Nursing Home Care

Question: Does Medicare really pay for the first 10 days of nursing home care?

Answer: The answer is bit more complicated than a simple yes or no. But it is certainly a myth that Medicare covers long term care. Regretfully, it’s a myth that many people believe: in a recent survey conducted by AARP, more than half of the respondents believed that Medicare will cover all of their nursing home costs. It just isn’t so. As of 2010, Medicare will pay for up to 100 days of skilled nursing care in a facility that will pay for up to 100 days of skilled nursing care in a facility that is certified by Medicare IF the following conditions are met:

  • Placement in a skilled nursing facility (SNF) is within 30 days of a hospital stay.
  • The stay in the hospital was for at least three days-but that doesn’t include the day of discharge-so it’s really four days.
  • The care is medically necessary, which is usually defined as skilled-nursing or skilled-rehab care.
  • The skilled care is directly related to the medical condition that resulted in the hospitalization.

If all of these conditions are met, Medicare may cover up to 100 days of skilled care. But remember, the care must be skilled, not chronic or custodial care. Skilled care must be medically necessary and prescribed by a physciian. The skilled care must improve or maintain the patient’s condiction and prevent it from further deterioration. The care requires registered nurses, physicians and orefessional therapitts who mangage, observe and evaluate the patient’s condition. Under this scenerio, Medicare will pay 100 percet pf your parent’s first twenty days in a nursing home. On average, most people need no more than twenty days of skilled care. Where they run into trouble is needing additional days of “chronic care,” which Medicare won’t cover.

If your parent needs additional “skilled” care beyond twenty days, Medicare will cover all but $137.50, which is your hefty daily co-pay, for days 21-100. The good news is that most Medi-gap policies (her supplemental insurance) will cover her co-pay. But after 100 days, there will be no Medicare payments or Medicare supplements.

A beneficiary can collect under this benefit period is not based on annual or lifetime basis. It begins when your parent enters a hospital and ends when there has been a break of at least 60 consecutive days since her inpatient hospital or skilled nursing care was provided.

The two most important things to remember are: always carry a Medi-gap policy which will cover the gap between what’s charged for the care and what Medicare will cover, and never assume that Medicare will cover nursing home care. If, during a hospital stay, your parent is told that she needs to be transferred to a facility that has been certified by Medicare so that she can receive the coverage that Medicare does provide.

If you have questions, be sure to ask to speak to the hospital social worker prior to discharge. Medicare also has an excellent website that features their downloadable handbook, Medicare Coverage of Skilled Nursing Care at www.medicare.gov. Enter Skilled Nursing Facility Coverage in the search bar and follow the prompts. You can also call them at 1-800-633-4227.

Information provided by Dr. Linda Rhodes, Finding Your Way, 250 Real Life Questions and Commonsense Answers http://lindarhodescaregiving.com/index.htm