If you are caring for an elderly loved one who needs skilled nursing care, you might wonder what will be covered by Medicare. It is important that you understand that Medicare will only pay for skilled nursing services. It will not pay for stays in custodial nursing facilities on a long-term basis. The staff at Elder Care Direction can help you to understand what Medicare will cover and the options that you have for your loved one’s other long-term care needs.
What are skilled nursing services?
Benefits for skilled nursing services fall under Part A. These services must be ordered by a doctor, medically necessary, and performed by skilled medical professionals. Medicare will pay for care in a skilled nursing facility if it meets the following conditions:
- Your loved one must have been admitted to a hospital for at least three overnights;
- Your loved one must subsequently be admitted to a Medicare-participating facility within 30 days of when he or she was discharged from the hospital; and
- Your loved one’s admission must be for the same condition that led to the original hospitalization.
If all of the conditions are met, then Medicare will pay all charges for the first 20 days of each benefit period. It will then pay everything except for a $161 copay per day for the following 80 days. The copay might be covered by private insurance or a Medicare supplement. After 100 days of a benefit period, the Medicare benefits will end.
What is a benefit period?
A benefit period starts on the day that your loved one is admitted to the hospital. It ends when your loved one has not received care in a skilled nursing facility for a minimum of 60 consecutive days.
After 60 days have passed without care, a new benefits period will begin. The beneficiary will be able to receive the same benefits as previously. New copays and deductibles will apply. Before a new benefits period can begin, the Medicare recipient will first have to stay in the hospital as an admitted patient for at least three overnights.
Even though there is the potential for 100 days of benefits for each benefits period, that doesn’t mean that your loved one will receive the full number of days. To continue receiving the benefits, your patient must be able to do the following:
- Be able to complete the therapies that have been prescribed
- Must be willing to do the prescribed therapies
- Must show progress in his or her treatment
If your loved one plateaus or stabilizes, he or she might not qualify for further skilled services even if he or she has not received 100 days of services. Medicaid may then step in to cover nursing home care.
Contact Elder Care Direction
Caring for your elderly loved one can be exhausting. If your loved one needs skilled nursing services, talk to the professionals at Elder Care Direction. You can schedule a consultation by filling out our online contact form.