Medicare is the federal health insurance program for people
who are 65 or older and certain younger people with disabilities or specific
diseases. Payments by Medicare for nursing home care, if any, are only provided
on a limited basis, and not for long-term needs.
There are many limitations. For example, Medicare requires a qualifying
in-patient hospital stay within 30 days of your nursing home admission. In
addition, Medicare requires that the patient is receiving daily skilled care in
the nursing home. Otherwise, you get no
payment from Medicare.
Most people residing
in nursing homes are not receiving what Medicare considers to be skilled care.
("skilled care" is care which involves skilled nursing or
rehabilitative personnel such as registered nurses, LPNs, or physical
therapists). Because of these
restrictions, most people who enter a nursing home don't get any Medicare
coverage at all.
And even if you do qualify for Medicare, it will only pay for
a limited period. As long as you meet
the prior hospitalization and skilled care requirements, Medicare will pay in
full for the first twenty days. After
that, if you continue to meet the skilled care requirement, you must pay the first
$167.50
a day [in 2018] and Medicare will pay the rest of the daily bill. (Many people have Medicare Supplement or
Managed Care coverage that will pay the initial $167.50 for them).
It turns out that Medicaid (not Medicare) is the
program that covers most (62%)
of nursing home residents. Consult with an experienced elder law attorney to
learn how you can qualify for Medicaid payment of nursing home or home care
costs.
Click
here for information
from Medicare.gov on the limitations of Medicare coverage of nursing home
costs.
