Many people erroneously believe that Medicare automatically covers long term nursing home stays. However, in order for Medicare to cover an individual's stay at a nursing home, a patient must satisfy the following 4 criteria:
1. Admission to the Hospital for 3 Days.
A patient must have been hospitalized for medically inpatient hospital care for at least 3 consecutive days. This date of discharge is not counted in this calculation..
2. Admission to a Nursing Home
A patient must be admitted to a nursing home within 30 days after the date of discharge from the hospital.
3. Skilled Nursing or Rehabilitation Care Required
A patient must require skilled nursing care (care that can only be administered by a professional such as a physician or nurse, or other personal which will prevent deterioration in the patient's health) or rehabilitation care, on a daily basis for which the patient was hospitalized.
4. Doctor's Orders
A patient must receive a doctor's order that such care is needed for the patient.
Time Limitation - Co-Pay
Medicare will only cover a patient in a nursing home for up to 100 days during any benefit period. Medicare pays in full the first 20 days of the nursing home stay, but the patient must pay a co-pay, which in 2018 is $167.50 a day. This amount is set by the Federal government on an annual basis.
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