Nursing Home Medicare Eligibility

Nursing home care is an unavoidable expense for many seniors. When the funding is not available, the cost can be devastating. Medicare will cover nursing home expenses, but certain requirements and criteria must be met. If the conditions are met, Medicare will pay for up to 100 days each benefit period. The benefit period begins when you enter the nursing home. The period ends when you are discharged and spend 60 consecutive days out of the nursing home.

Need for Care

• Medicare will only cover nursing home expenses if you require the highest level of care, known as skilled nursing. This type of treatment is performed at a Skilled Nursing Facility. You are also required to spend at least three consecutive days in a hospital. The stay cannot be more than 30 days prior to admission in a nursing home and must be related to the need for skilled nursing.

Services Covered

• Medicare will pay for a semi-private room only. This means you will be sharing the room with another patient. Meals are also included. The care you receive at a skilled nursing facility can include physical therapy, occupational therapy, speech-language therapy, ambulance transportation, medical, medical supplies and equipment used in the facility and dietary counseling. Medicare will not cover custodial care, which is help with daily activities such as bathing and taking care of catheters.

Approved Facilities

• Medicare will only cover treatment at an approved Skilled Nursing Facility that is licensed and inspected by the State Department of Health Services. Skilled Nursing Facilities offer both short- and long-term care. Services received will vary, depending on the facility. The Nursing Home Compare feature on the Medicare website allows to search for Medicare-approved nursing homes in your area.

Medicaid

• Although Medicare does not cover long-term care, Medicaid does pay for nursing home expenses for long periods. If you are a low-income Medicare recipient with limit resources, consider applying for Medicaid to cover your treatment. Medicaid is a federally-funded program, but requirements vary from state to state. Even if you do not qualify for coverage immediately, spending-down assets can make you eligible down the road. Visit your local Department of Social Services for information on applying for Medicaid for long-term care.