How does Medicare cover Skilled Nursing?

Long Term Care?  *  Home Health Care?

Skilled nursing facility care

 

Medicare covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services and supplies furnished in a skilled nursing facility after a 3-day minimum, medically necessary, inpatient hospital stay for a related illness or injury. An inpatient hospital stay begins the day the hospital formally admits you as an inpatient based on a doctor’s order and doesn’t include the day you’re discharged. You may get coverage of skilled nursing care or skilled therapy care if it’s necessary to help improve or maintain your current condition.

To qualify for skilled nursing facility care coverage, your doctor must certify that you need daily skilled care (like intravenous injections or physical therapy) which, as a practical matter, can only be provided in a skilled nursing facility if you’re an inpatient.

You pay:

• Nothing for the first 20 days of each benefit period
• Coinsurance per day for days 21–100 of each benefit period
• All costs for each day after day 100 in a benefit period

Note: Medicare doesn’t cover long-term care or custodial care.

• Skilled nursing facility care coverage
• Skilled Nursing Facility Checklist [PDF]
• Assessments
• Care plans
• Your rights in a skilled nursing facility
• Reporting & resolving problems
• Get help paying for skilled nursing facility care
• Find hospitals & skilled nursing facilities

Resources & Links

medicare.gov/-skilled-nursing-facilities

Medicare & You – See link in side panel

Pamphlet on Skilled Nursing from Medicare 

 

Home health services

You can use your home health benefits under Part A and/or Part B to pay for home health services. Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, or continued occupational therapy services. A doctor, or certain health care professionals who work with a doctor, must see you face to-face before a doctor can certify that you need home health services. A doctor must order your care, and a Medicare-certified home health agency must provide it.

Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. You must be homebound, which means:

• You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
• Leaving your home isn’t recommended because of your condition.
• You’re normally unable to leave your home because it’s a major effort.

You pay nothing for covered home health services. You pay 20% of the Medicare-approved amount, and the Part B deductible applies, for Medicare covered medical equipment. ^{copied from Medicare & You – see brochure in side panel} *

Learn more 

Skilled Nursing Official Booklet

Home Health Official Booklet

View our pages on Long Term Care

Long Term Care

• Activities of Daily Living
• Can’t afford premiums or not medically qualified
  • Low Income – Assets Assistance – Alternatives
    • Medi-Cal Qualification – Nursing Home
      • ALW – California Assisted Living Waiver
      • Medi Cal – Estate Recovery
      • Strategic Planning – Medi-Cal
• Employer Groups – Long Term Care
• Life Insurance vs Lump Sum Payment
  • Annuities to pay for Long Term Care – 1035 Exchange
• Mutual of Omaha LTC
• Nursing Homes – Assisted Living – Finding and Selecting the best ones
  • Assisted Living – Residential Care Facility
  • CCRCs Continuing Care Retirement Communities (CCRCs)
  • Home Health Care – Finding
  • South Bay Nursing Homes