Medicare: Does Medicare cover Nursing Home costs?

Medicare is a Federal insurance program for that pays for hospitalization – Part A; doctors – Part B; Medicare Advantage – Part C; and prescriptions – Part D.  Almost everyone who pays the FICA withholding out of their paychecks will receive Social Security, and will be eligible for Medicare supplement insurance. Note that while the Social Security retirement age in now 66, Medicare still starts at age 65.  Early retirees, those taking Social Security at ages 62, 63, and 64, are not eligible for Medicare until age 65.

In the context of Nursing Home care, Medicare is a minimal player for long term care, paying only about 8% of Nursing Home costs.

If a Medicare eligible person has been hospitalized for three consecutive nights and then receives a rehabilitative discharge, Medicare will pay for up to 20 days of Nursing Home care if they enter a Nursing Home within thirty days of their discharge. Most people go directly from the hospital to the Nursing Home.

After the first 20 days, there is the potential of an additional 80 days available. In order to receive any part of the 80 days, the Nursing Home resident must be maintaining. Medicare terminates as soon as the resident stops making progress. Expect no more than 24 hours notice from the Nursing Home prior to Medicare termination. Additionally, there is a very large co-pay for any part of the 80 days received – $141.50 per day for 2011. Some Medicare supplements will pay the co-pay, some will not, and some will only pay part of the co-pay.

Most Nursing Home residents do not receive the full 80 days of additional coverage, especially those admitted with cognitive issues, since they often make little or no progress. Once Medicare ends, the choices are private pay at around $8,000 per month, long term care insurance [which most older folks do not have], or Medicaid.

If you have questions or would like to schedule a free consultation with us, please feel free to contact us, we’re here to help.

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