Will black lung benefits or Medicare Parts A and B pay for a skilled nursing home?

1 answer | Last updated: Nov 25, 2016
A fellow caregiver asked...

My father has Black Lung benefits and Medicare A & B. Will either one of these pay for a skilled nursing home?

Expert Answers

The answer's a mixed bag. Federal Black Lung benefits do not cover inpatient costs in a skilled nursing facility, but Medicare Part A can cover some skilled nursing facility care. The rules of Medicare Part A nursing facility coverage are quite strict. Medicare can cover a skilled nursing facility stay for your father only if:

  • His stay in a nursing facility begins within 30 days following his stay in a hospital that lasted at least three days;
  • He needs, and his physician prescribes, daily skilled nursing care or physical rehabilitation (if your father needs skilled care but doesn't need it every day, Medicare could cover home care);
  • The facility where he gets care is Medicare-certified for that purpose; and
  • His condition is improving with the care he receives there (once his condition has stabilized, Medicare will no longer cover skilled nursing facility care).

If your father meets all these conditions, Medicare Part A can cover some of the cost of his care, for a limited time. During any one benefit period, Medicare pays all covered charges for the first 20 days in a skilled nursing facility. For days 21 to 100 during any one benefit period, Medicare pays all covered charges except a daily "coinsurance amount" of $128 per day, which your parent is personally responsible for. If your father has a private medigap supplemental insurance policy, that policy might pay some or all of this coinsurance amount. After 100 days in a covered nursing facility in any one benefit period, Medicare no longer pays any of the cost. The rules are explained in detail in this site's article Medicare and Long-Term Care: What's Covered, What's Not.