When Will Medicare Pay for a Nursing Home?
By Rick Law of Law Elder Law in Aurora, IL, Serving Seniors and Boomers in the Western Suburbs. Many people are under the misconception that Medicare will pay for the bulk of their long-term care services. However, nationally, Medicare covers only about 5 percent of all nursing home costs, and the parameters for qualification are many. If you have a condition needing short-term care, such as rehab following a surgery or care following an accident, then there is a chance you may qualify for some skilled nursing facility benefits from Medicare. In order to qualify to receive skilled care in a nursing facility, for example, a patient must meet all of the following criteria:
- Require daily skilled care, which as a practical ma!er, can only be provided in a skilled nursing facility on an inpatient basis.
- Be in the hospital for at least three consecutive days – not including the day of discharge – before entering a skilled nursing facility that is certified by Medicare.
- Be admitted to the skilled nursing facility for the same condition for which the patient was treated in the hospital.
- Generally be admitted to the skilled nursing facility within 30 days of their discharge from the hospital.
- Be certified by a medical professional as needing skilled nursing or skilled rehabilitation services on a daily basis.
- All approved charges for the first 20 days are fully paid by Medicare.
- After day 20, the patient will be responsible for a daily co-insurance amount of $141.50 (in 2011).