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Long-Term Care Planning – Frequently Asked Questions
Medicare

1. Will Medicare pay for nursing home costs?

If a Medicare recipient is admitted to a hospital for 3 or more consecutive days, and then discharged to a Skilled Nursing Facility (SNF), Medicare will pay for up to 100 days of skilled care (e.g. wound care, rehabilitation, therapy, etc.) per benefit period or spell of illness:

  • Days 1 – 20: Medicare pays in full with no patient co-pay
  • Days 21 – 100: Patient responsible for co-pay of $164.50/day in 2017, Medicare pays the balance
  • Most individuals do not receive more than 2-3 weeks of skilled care
  • Actual number of days authorized will vary depending on:
  • Physician’s verification of necessary care;
  • Whether patient participates in therapy and continues to improve; and
  • Whether patient’s level of function will decline without more care.
  • Medigap or Medicare Supplement policies may cover the co-pay for days 21-100

2. Do all hospital stays trigger SNF benefits under Medicare?

In order to qualify for SNF benefits, the Medicare recipient must be admitted to the hospital for at least three days. Each day is a 24-hour period, “Discharge” days do not count towards the three day minimum, and “extended observation stays” where the patient is not actually admitted on an inpatient basis do not count.

3. What is a “Spell of Illness” for purposes of Medicare SNF benefits?

A spell of illness begins on the first day of admission for Medicare-covered inpatient care in a hospital or SNF. The spell of illness continues until the patient has received no Medicare-covered facility care for 60 consecutive days.