Medicare Part A covers up to 100 days of skilled nursing care provided certain conditions are met. Here are the main requirements:
- The Medicare recipient must enter the nursing home no more than 30 days after at least a three day hospital stay.
- The nursing home care must be for the same or medically related condition that caused the hospitalization.
- The patient must receive a “skilled” level of care that cannot be provided at home or on an outpatient basis. To be considered “skilled”, the care must be ordered by a physician and delivered on a daily basis by or under the supervision of a nurse or other licensed professional.
Medicare covers the first 20 days of skilled care with a co-pay of $161.00 for days 21 through 100. A new 100 day period can begin for a new spell of illness if the patient has not received skilled care for a period of 60 consecutive days. It is not uncommon for nursing homes to improperly terminate Medicare coverage on the basis that the patient is no longer making progress towards recovery. In fact, provided the patient needs continued skilled care to maintain his or her status, then the skilled care should continue.