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How does someone qualify for nursing home coverage by Medicare?

Medicare Coverage of Nursing Home Care: Page 2

By , Caring.com Expert
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In order for someone to receive nursing home coverage by Medicare, a number of different conditions have to be met:

  • Prior hospital stay: A patient's stay in a skilled nursing or rehabilitation facility has to begin within 30 days of an inpatient hospital stay of at least three days (not including the day of discharge).

  • Need for daily skilled nursing or rehabilitation: Medicare provides nursing home coverage only if the patient needs, and his or her physician prescribes, daily skilled nursing care or physical rehabilitation. For someone who needs skilled care but doesn't need it every day, Medicare won't cover nursing home care. However, in that situation Medicare might cover home care.

  • Medicare-approved facility: For Medicare to cover inpatient skilled nursing or rehabilitation care, the care must be received in a facility that Medicare has certified for that purpose.

  • Improving condition: Medicare covers nursing home care only as long as the patient's condition is improving. Once Medicare, the patient's doctor, and the facility have determined that his or her condition has stabilized, Medicare will no longer cover inpatient nursing home care.