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Does Medicare Pay for Nursing Home Costs?

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Jon J. Gasior, Attorney  When considering how you will pay for nursing home costs, most people think of the following sources of payment: their income, their assets, maybe Medicare, maybe Medicaid and long term care insurance. They are certainly correct in thinking that their income and assets can pay for a nursing home. Long term care insurance will often pay depending on the policy coverage. Medicaid will pay for nursing home expenses, but there are certain asset limits that may prevent you from qualifying if you do not meet those limits. Medicare MAY pay for a PORTION of a nursing home stay.

Now that some of the options have been identified, let’s explore how Medicare long term care payments work. It is first important to know that Medicare will only cover ”skilled nursing care”. What does this mean? Examples of skilled nursing care are IV injections or physical therapy. Custodial care such as assistance with bathing or dressing does not qualify as skilled nursing care. The types of professionals that provide skilled care are registered nurses, licensed practical nurses, physical and occupational therapists, speech language pathologists, and audiologists.

So what other requirements are there for Medicare skilled nursing coverage?

1)      You must have Medicare part A,

2)      you must have had a qualifying stay in a hospital meaning a hospital stay of 3 consecutive days or more starting with the day you are admitted as an inpatient

3)      Your doctor has ordered the skilled nursing services you require,

4)      You require the skilled care services on a DAILY basis,

5)      You need these skilled care services for a medical condition that was treated during your qualifying hospital stay

6)      The skilled services must be reasonable and necessary for the diagnosis or treatment of your condition,

7)      You get your skilled nursing services in a facility that is certified by Medicare.

Even if you meet all of these requirements, Medicare will not pay for all of your nursing home care.  Medicare will pay the entire amount for days 1-20 in the skilled nursing facility.  For days 21-100, Medicare will pay for all but $152, which is your co-payment.  And Medicare will not pay anything for skilled nursing care for any stay longer than 100 days.

Paying for long term care can be a daunting task, especially with the rising cost of such care. It is important to know what services will pay and for how long. This is a crucial part of your estate plan, and something to discuss with your estate planning attorney.

https://spgasior.com/services/elder-law-medicaid-services/.

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