Medicare & Long Term Care Coverage

Medicare is a federal health insurance program for people 65 and over and certain disabled people under 65. Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is divided into two parts: Hospital Insurance (Part A); and Medical Insurance (Part B).

Medicare and Nursing Home Coverage

Most nursing home care is custodial care. Medicare and supplemental Medicare insurance generally does not pay for custodial care or long-term care. Medicare also does not pay for help with activities of daily living. Examples of activities of daily living include eating, bathing, dressing, and toileting.

Nursing home care and nursing home facility coverage falls under Part A of Medicare. Medicare only covers skilled care given in a certified skilled nursing facility (SNF).

• 1-20th Day
  Under certain conditions, Medicare will pay fully for the first 20 days of care in a skilled nursing home.
  
  
• 21st-100th Day
  For the 21st through the 100th day, the patient must pay the daily coinsurance rate for the cost of care (a co-pay). In 2005, the Skilled Nursing Facility coinsurance payment is $114 per day. Medicare pays 80 percent up until the 100th day.
  
  
• 101st Day and afterwards
  After day 100, Medicare will not pay anything.
  

Medicare Pays for Nursing Home Care Only Under the Following Conditions:

• The nursing home is a skilled nursing facility (SNF) which is Medicare certified. SNFs provide 24-hour nursing care to convalescent patients;
  
  
• The patient requires continuous skilled nursing care or skilled rehabilitation services on a daily basis;
  
  
• The patient has spent at least three consecutive days in a hospital and is admitted to a nursing home within 30 days after discharge from the hospital for the same condition;
  
  
• A physician certifies that that skilled nursing home care is needed for the same or related illness for which the person was hospitalized.

Services Covered by Medicare

• A semi-private room
• Meals, including special diets
• Regular nursing services
• Rehabilitation services
• Drugs furnished by the facility
• Medical supplies

Services Not Covered by Medicare

• Personal convenience items
• Private duty nurses
• Extra charges for a private room
• Medicare Part B may help pay for covered services you receive from your doctor in a skilled Nursing Home.

How to Apply for Medicare

Contact your nearest Social Security office to find out if you are automatically covered for Part A because of credits for the number of (calendar) quarters worked in your lifetime. Also, if you are interested in signing up for Medicare medical insurance (Part B), the Social Security office can assist you with that process. Keep in mind, though, that you can only sign up for the insurance in the first three month of the calendar year.

Medicare Eligibility

You can use the Medicare Eligibility Tool to provide you with information about your Medicare eligibility and enrollment.