Florida Senior 360 | Florida elder resource-learn about Medicare coverage for seniors staying in a Nursing Home.

I thought Medicare would pay for 100 days in the Nursing Home

TRUE or FALSE

As a social worker in the nursing home industry I have had families come to me on a daily basis and say, “My mom has 100 days to stay here and Medicare will pay for it.” This is a common misconception because it is not the complete story. Medicare will only pay 100% of the costs for the first 20 days and on the 21st day Medicare will pay 80% of the costs. You are responsible for the remaining 20%, which may be covered by supplemental/secondary insurance. Even more importantly, Medicare will only pay as long as an individual is receiving “skilled care.”

Medicare allows you 100 days in the skilled nursing/rehabilitation center, but they will never pay for long term care in a nursing home. This can be such an overwhelming time for families and patients and they often cannot process all the information they are told. Many families only have a few hours or perhaps 1-2 days to find a nursing home for their loved one. When this is the first time they are faced with this issue it can be very stressful.

To enter a skilled nursing home under the Medicare benefit an individual must be transitioning from a stay in the hospital for 3 nights. It is referred to as the 3 midnights – meaning you have to be an admitted patient in the hospital for 3 midnights prior to accessing Medicare benefits for the skilled nursing facility. When transitioning from the hospital to the nursing home there is a mountain of paperwork to complete. Usually the admissions director will review the information with you and walk you through the process.

Furthermore, to access a Medicare benefit an individual needs to be receiving care at a skilled level in the nursing/rehabilitation center. Skilled care can be physical and occupational therapy, a nursing level of skilled care for possible wounds or complex medical care. Consult with the social worker in the nursing/rehabilitation center for further assistance. Refer to the Medicare & You 2008 handbook for a list of skilled services.

Download Medicare & You 2008 handbook in PDF format.