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Will Medicare pay for my nursing home care?

Will Medicare pay for my nursing home care?

A:
Unfortunately, the answer is both yes and no. Medicare pays for only a limited amount of nursing home care and only if you qualify under Medicare rules.

Here are the basic qualification requirements: First, you must have an inpatient hospital stay of three consecutive days. This does not include the day you leave the hospital. It also does not include time you are in the hospital before you are officially admitted. You must have Medicare part A coverage. Third, you need skilled nursing care which your doctor has ordered. (This includes rehabilitation professionals in addition to just nurses.) Therefore, if you just need “custodial care,” you will not qualify for Medicare payments. Custodial care essentially means that you just need help with your activities of daily living such as getting dressed, getting out of bed and bathing.

Here are the financial limitations: First, Medicare pays the full cost of the nursing home for only the first 20 days. Second, Medicare pays nothing after 100 days. You pay a copayment per day between days 21-100. This copayment amount changes from year to year. In 2008 it was $128 a day. This, of course, is a lot of money. To be exact, for 80 days it is $10,240. If you have new hospital stays, you can qualify for additional 100 day periods.



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