If a patient meets the qualifying conditions for Medicare coverage of nursing home care, Medicare will pay only a limited amount for it.
For the first 20 days in a facility, Medicare pays all covered charges -- excluding items such as a telephone or television, or a private room if it's not medically necessary.
For days 21 to 100 in a nursing facility during any one benefit period, Medicare pays all covered charges except a daily "coinsurance amount" for which patients are personally responsible. In 2012, that amount is $144.50 per day. If the patient has a private Medigap supplemental insurance policy, that policy might pay some or all of this coinsurance amount.
After 100 days in a covered skilled nursing facility in any one benefit period, Medicare no longer pays any of the cost.
If the patient is enrolled in a Medicare Part C Medicare Advantage plan, the plan may provide broader coverage than Medicare Part A does. Contact the plan directly to find out what its nursing home coverage and payment terms are.
Where can I get more information about Medicare coverage for nursing facility care?
If the person you're caring for is in the hospital and you're looking for answers about follow-up nursing-facility care, contact the hospital's discharge planner, who can arrange this type of care, or the hospital ombudsman, who's trained in Medicare issues and helps patients understand them.
You can also get information about Medicare nursing home coverage directly from Medicare's website or by calling (800) 633-4227. If the person you're caring for has already been referred to a particular nursing facility, the intake administrator for that facility can also help with Medicare-related questions or problems.
