Does Medicare Pay for the Nursing Home?

by Kellen Bryant

In this article, I’m going to answer the question, “Does Medicare pay for a Nursing Home?”

First, you need to have Medicare coverage.  That mean’s you’re over 65 or you have been on social security disability for more than 24 months.

To see my video answering this question, click here.

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If you have Medicare, you must be admitted into the hospital instead of only going there for observation status.

As it applies to getting nursing care coverage, if you’re there under observation status, then Medicare, as it stands today, will not pick up the nursing home bill after you leave the hospital. You want to make sure that you are being admitted.

After being admitted…

Next, you need to have a qualifying stay at the hospital. This means after just three days in the hospital, you have a qualifying stay. Then, when leaving the hospital, if the discharge planner and the doctors say that you need rehabilitative care in a nursing home, Medicare will cover the first 20 days of rehab in a nursing home. Under these circumstances, Medicare will pay the nursing home.

This detail is key: the rehab must be helping you…

One of the key on all these day/length requirements that I’m discussing is that you are doing the rehab. You’re not plateauing, as what key term you will hear. There are some issues in recent case law about this “improvement” standard. It is recent case law. You could fight on that if your insurance is claiming you’re not improving. It is common practice you have to be improving.

Between day 21 and day 100, depending on your Medicare supplement, you can also get that fully covered. If you don’t have a good supplement, you’re paying around $150 a day from days 21 to 100. Therefore, it’s very important to have the right Medicare supplement.

After day 100, Medicare no longer pays the nursing home, and you are going to be in private-pay situation or you’ll need to be looking for Medicaid coverage.

If this topic interests you, the difference between Medicare and Medicaid, I have a video and an article where I explained that topic previously.

If you are at the point where you’re either on day 21 paying $150 a day, or you’ve been in this place for more than 100 days, you need to contact an elder law attorney in your area to help with qualifying for Medicaid and protecting assets from having to spend it completely down on nursing care.

If you need help on finding the right attorney for you, you can order my book on amazon by clicking here. 

To summarize, in order for Medicare to cover the full 100 days in a nursing home, you must:

  1. Have Medicare coverage
  2. Be admitted to the hospital, not under observation status
  3. Stay in the hospital for 3 days
  4. Go to a rehab facility that accepts your Medicare supplement for coverage after day 2o of rehabilitation

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