Many families mistakenly believe that Medicare will cover the cost of nursing home care and expenses when their loved one is ill and in need of long-term health care. In this post we will examine the circumstances in which Medicare will pay for the cost of nursing home care and expenses and how much financial assistance they provide families seeking nursing home care for a loved one.


What Nursing Home Care Does Medicare Cover?

Generally, there are two types of nursing home care – custodial care and skilled nursing care. Custodial care involves helping individuals with daily living activities such as eating, bathing, dressing, and toileting.

Skilled nursing care involves helping individuals who need medical care that can only be provided by a registered nurse or licensed practical or occupational practitioner, like a speech pathologist. Examples of medical care that can only be provided by a registered or specialized nurse are wound care, physical therapy, respiratory therapy, or occupational therapy.

How can My Nursing Home Stay Qualify for Medicare Coverage?

Medicare will cover the cost of nursing home care, for a limited time, under the following circumstances:

● You must have had a hospital stay of three or more inpatient days;
● You must have available days left in your Part A benefit period (Medicare may cover up to 100 days per benefit period);
● Your doctor must indicate that skilled nursing care is medically necessary to treat your condition;
● You receive the required skilled care on a daily basis;
● Your nursing home stay need is related to the condition you were treated for in the hospital or a new condition started while you were receiving nursing home care for the ongoing condition; and
● The nursing home facility is certified by Medicare.

How does Medicare Help Pay for the Cost of Rehabilitation?

When Medicare covers a nursing home stay, it is almost always for the limited purpose of rehabilitation. Keep in mind that Medicare will only pay for the cost of rehabilitation under specific circumstances, like following in-patient admission in the hospital.

When an individual is discharged from the hospital, after in-patient admission of at least three days, they may be directed to go into a skilled nursing home facility for rehabilitation. The first 20 days of care are typically paid by Medicare.

Days 21 to 100, however, are not covered by Medicare. Private insurance and/or a Medicare supplement policy, after a hefty deductible, are able to help cover the cost of the remaining days – or days 21 to 100, if the individual has private insurance and/or a Medicare supplement policy. At least 100 days under this scenario are covered under Medicare, a Medicare supplement policy, and private insurance.

If the individual no longer needs rehabilitation or voluntarily stops rehabilitation, then the Medicare payments stop, followed by Medicare supplemental insurance and private insurance. If the individual still needs nursing home care, the families will have to look for other ways to pay for the cost of care. One way that may be available is the Medicaid program. Check back next month when we review how Medicaid helps pay for nursing home care.

Medicaid can Help Pay for Nursing Home Care

Long term health care planning is the foundation of any estate plan. Ask an estate planning attorney in Paramus, New Jersey today about an estate plan, including short-term and long-term medical care for you and your spouse. Helping families with their elder law, family law, and estate planning needs in Paramus, New Jersey, our estate planning attorney can help with Medicaid planning, special needs planning, probate, veterans’ aid, and more. To request a consultation, click here or call (201) 690-1642 now.

For more information, please visit https://girolaw.com/ask-an-estate-planning-lawyer-in-paramus-nj-retirement-plans-under-tax-2-0/
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