Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. Medicare is not meant to be used to cover the entire cost of an extended nursing home stay.
Medicare covers up to 100 days of "skilled nursing care" per illness, but there are a number of requirements that must be met before the nursing home stay will be covered. To be covered, you must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay, typically at least three days. What many people do not realize is that in today's hospitals, it is unlikely, if not rare for patients to stay for a full three days.
In addition, an individual or their family cannot simply request skilled nursing care for Medicare to pay for it. Instead, a physician must order skilled nursing care.
This is where it gets tricky because Medicare is only going to cover the expenses related to how they define acute care as opposed to custodial care. This means that Medicare is only going to pay for care for people who are likely to recover from their conditions. For example, if someone falls and is injured, but with care, therapy and assistance, will be able to return home, Medicare is likely to pay for such care. It does not, however, provide financial support for people who need ongoing help with performing everyday activities, such as bathing or dressing.
Once you are accepted into an approved Medicare facility, Medicare will cover the cost of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies. The good news is that Medicare covers 100 percent of the costs for the first 20 days. But what many people do not realize is that beginning on day 21 of the nursing home stay, there is a significant co-payment ($128 a day in 2008). If you have purchased a Medigap insurance policy, then this copayment may be covered, though it depends on the policy.
Not all nursing homes are approved by Medicare. However, our nursing home directory, has a comprehensive listing of over 15,000 nursing homes in the United States which are covered by Medicaid (and Medicare) and includes 5-Star Quality Ratings to help you make an informed decision.
In traditional health care, many physicians prefer to have self-paying patients as agreements with health insurance companies often severely limit the billable totals. In the same way, nursing homes also prefer to fill their limited beds with self-pay residents. Nursing homes will usually set aside a certain number of those beds for residents with a specific type of insurance (like Medicare or Medicaid). When those slots are filled, you or your loved one may need to go on a waiting list, even if the nursing home is not at full capacity.
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