Understanding Medicare Coverage for Nursing Home & Skilled Nursing Care

While long-term nursing home care is not covered by Medicare, short stays in skilled nursing facilities are. Coverage is determined by both the length of the stay as well as the necessity of the skilled nursing care.

Medicare

• Medicare is a federal government program that provides health coverage for qualified people who are over the age of 65.

Type of Care Covered

• Medicare does not pay for assistance with day-to-day living tasks such as dressing and bathing. Medicare will pay for skilled care from medical professionals such as nurses and physical therapists. (See References 2 and 3)

Skilled Nursing Facilities and Nursing Homes

• A skilled nursing facility provides medical care for those who need it. While some nursing homes do provide skilled nursing facilities, many focus on providing day-to-day care for their residents.

Qualifications

• For a stay in a skilled nursing facility to be covered by Medicare, the patient must have been hospitalized for at least three days, before being transferred to a Medicare-certified skilled nursing facility.

Time Limits

• Medicare will cover all costs of a skilled nursing facility stay for up to 20 days. After 20 days, the patient is responsible for a daily co-payment for up to 100 days of care. Medicare does not pay anything after 100 days in a skilled nursing facility.