In this Elder Law Minute, Wes Coulson discusses if Medicare will pay for someone’s nursing home stay.
I want to talk today about whether Medicare will pay for someone’s nursing home stay. Quick answer: Only for a little while, if certain conditions are met.
What are the conditions?
- First of all, you still have to have part of your Medicare Part A days left for the year. So other circumstances might limit the amount that you have available.
- You have to have a three day minimum inpatient hospital stay. If you’re there under observation, that doesn’t count as an inpatient stay.
- You need to go into the nursing home based on a doctor’s advice within thirty days after that stay
If all of those conditions are met, Medicare will pay for your care during the first 20 days, and will pay subject to a deductible, that for 2020 is $176 a day, up to the next 80 for a total of 100. But in each case, only if you are still getting skilled care, which most of the time means physical, occupational, and/or speech therapy.
There is a whole separate question, by the way, about when therapy should be continued so that Medicare will still pay for it. Don’t count on the 100 days. The typical is closer to 30. As to that deductible, if you have some Medicare supplement insurance policies or Medicare Complete, they will pick up the deductible again, only in some instances. So that is something you need to call the carrier about right away and find out whether you’re going to have to pay that first $176 a day for those days beyond the first 20 days.
One other hint on this, we call that the “Window of Opportunity” for Medicaid planning. Most of the time when people are in for rehab, they wind up staying longer term in the nursing home, so that time during Medicare days is a great opportunity to do some planning while you have somebody other than your own pocket paying for care.
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