How much will it pay?
Medicare Part A will cover your nursing home costs as follows;
- Days 1-20………………100% for each benefit period
- Days 21-100……………you will have a co-pay [you will be responsible for paying $157.50 per day] for each benefit period.
- Days 101 and beyond - $0 – you will be responsible for the full amount
Who is eligible?
Medicare will cover your nursing home costs at the rate described above under the following conditions:
- You have Part A and have days left in your benefit period
- You have a qualifying hospital stay [minimum 3 consecutive day in-patient hospital stay and are discharged directly to a nursing facility].
- Your doctor has decided that you need daily skilled care given by, or under the direct supervision of a skilled nursing or therapy staff. [If you're in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they're offered].
- You need these skilled services for a medical condition that was either:
2. A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition
- You receive this care in a facility that is certified by Medicare
Note: An inpatient stay begins on the day you’re formally admitted to a hospital with a doctor’s order. That’s your first inpatient day. The day of discharge doesn’t count as an inpatient day. Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an in-patient or if you can be discharged. During the time you're getting observation services in the hospital, you're considered an outpatient—you can't count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. Find out if you're an inpatient or an outpatient.
What is covered?
Medicare-covered services include, but aren't limited to:
- Semi-private room (a room you share with other patients)
- Skilled nursing care
- Physical and occupational therapy*
- Speech-language pathology services*
- Medical social services
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
- Dietary counseling
*Medicare covers these services if they're needed to meet your health goal.
Breaks in Nursing Home Care:
If you stop getting skilled care in the nursing home, or leave the nursing home altogether, it is considered a “break” period, your coverage may be affected depending upon the following.
- If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
- If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits.
Medicaid - a joint federal and state program will pay your nursing home costs after the 20 days of 100% Medicare coverage from a hospital stay or right from the start of your admission to a nursing home if you have not had a hospital stay. Get started on the application process as soon as possible to be sure you don’t have any lapse in coverage. Medicaid applications may take up to 4 months to be approved.
Want to be sure that you don’t have any nursing home costs? Contact us today, we can help ensure that your Medicaid coverage is in place.
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