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When does Medicare cover nursing home care?

Sep 21, 2020 | Long-Term Care Planning

Placing an elder loved one in a nursing home is often a difficult decision. However, you may feel more comfortable doing so if you are confident in the quality of care a home provides. You may have limited income to work with when determining where to place your loved one, though, which may make it difficult to find a place that meets you and your loved one’s criteria.

If your loved one is a recipient of Medicare, you may have questions about whether he or she may use this coverage to cover the costs of nursing home care. The short answer is, Medicare covers the costs of nursing home care only in very specific circumstances.

When Medicare pays for nursing home care

In rare cases, Medicare Part A, which is a specific component of the Medicare system, may cover your loved one’s short-term stay in a skilled nursing facility.

If your loved one’s doctor recommends that your loved one undergo specialized care in a skilled nursing facility following a hospital stay, Medicare may cover associated costs for up to 100 days. However, your loved one must enter that skilled nursing facility within 30 days of leaving the hospital for this to be possible. The stay in the nursing facility must also be for the same condition your loved one received treatment for while in the hospital.

When more care is necessary

If your loved one needs more care than he or she receives in those 100 days, your loved one must not undergo hospitalization for at least 60 days. If he or she undergoes hospitalization after 60 days have passed and a doctor orders skilled nursing services, Medicare may cover another 100 days of care.