Nursing Home Cost

Skilled care, provided by nursing homes (also known as skilled nursing facilities), is often needed on a short-term basis by seniors who have been hospitalized due to illness or injury. Medicare provides coverage for skilled care on a short-term basis when the following criteria are met:

• A senior is currently receiving Medicare Part A (Hospital insurance) benefits and is therefore 65 years or older or has been formally diagnosed with renal failure.
• A hospital stay of three or more consecutive days (three midnights) within the past 30 days.
• A physician has determined that skilled care and/or rehabilitation is medically necessary due to a current health condition.
• The skilled services required are provided in a facility that has been certified by Medicare.

If all of these conditions are met, Medicare will contribute to the nursing home cost required on a short-term basis (for up to 100 days). Specifically, Medicare will provide 100% coverage for skilled nursing costs for the first 20 days of a nursing home stay. From day 21 through day 100 of the benefit period, the patient is responsible for paying approximately $130 per day.

A benefit period ends when skilled care or rehabilitation has not been provided by the nursing home for 60 days. In such cases, Medicare no longer covers nursing home costs unless a patient experiences another qualifying hospital stay. Nursing home care provided from this point on is typically considered long-term care and patients must rely on other types of insurance coverage or pay privately.

Other payment types include long-term care insurance (which does not cover pre-existing conditions), Medigap policies and/or veteran’s benefits. Those who pay privately will commonly spend down their assets to qualify for Medicaid, a state-administered program for low-income individuals or families.