When discussing long term care planning, many people believe that Medicare will pay for their nursing home care. Medicare is the federally funded health insurance received by most people upon attaining 65 years of age. However, Medicare will only pay for skilled nursing care under certain circumstances and then only for a limited period of time. As a result, Medicare only pays for about 2% of the total cost of nursing home care.
Traditional Medicare coverage will only provide skilled nursing home care when you have been discharged from a hospital stay of at least 3 days to a Medicare-approved skilled nursing facility within 30 days of discharge when you require “skilled” care for treatment of the condition for which you were hospitalized. If you meet all of these conditions, Medicare will pay 100% of the cost of your care for up to 20 days. From Day 21 through Day 100, Medicare will pay any amount due over $152 per day (2014 figure). Medigap insurance may cover the co-insurance payment. But, keep in mind that Medicare only pays as long as you require “skilled” nursing care – that is, care under the daily supervision of a doctor, registered nurse, physical therapist or other licensed professional. After the 100 days, Medicare pays nothing towards cost of the nursing facility. With some Medicare Advantage plans or Medicare HMO or PPO plans, the number of days and the co-insurance payment per day may vary. To better understand what your own Medicare plan or Medigap plan covers, it is best to discuss long term care planning with an elder law attorney.