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Medicare, as a rule, will not pay for nursing home care. There is an exception, although the exception is a small one.
If a nursing home resident was admitted following a three day qualifying hospital stay, then Medicare may pay for up to 100 days of nursing home care. The rules regarding how this works are as follows:
- The care received by the resident must be "skilled" This means that he or she must receive health care or therapy, and that it must be performed by a trained technician or professional;
- The resident must have been in a hospital for at least three (3) days prior to going into the nursing home and the hospital stay must have ended no more than 30 days from entry in the nursing home;
- A physician must order that nursing home care is required every day for the same condition that caused the hospitalization; and
- The nursing home must be a Medicare-approved skilled facility.
Assuming the criteria outlined above are met, Medicare will pay 100% of the cost for first 20 days of skilled nursing care and will pay all but the daily co-pay for days 21 through 100. For those persons who purchased Medicare Supplements (Medi-gap policies), most plans will pay the daily co-pay, which results in up to 100 days of coverage. However, you should keep in mind that there is no guarantee of 100 days; coverage continues only while "skilled" care is necessary.
42 U.S.C. Section 1395x(i) (outlining requirements for post-hospital extended care)
42 U.S.C. Section 1395i-3 (defining "skilled care)
42 CFR Section 409.33 (outlining meanings of skilled care, rehabilitation services and what services are not covered).
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