Did you know Medicare never extends coverage to a patient who needs custodial care only? The custodial care may be provided as part of the Medicare skilled nursing home coverage that is partially provided by Medicare Part A. There are many restrictions, however, that apply to Medicare coverage for skilled nursing facility care.
What you may not realize is that nursing care requires that the care must be provided by or requires the supervision of skilled nursing personnel or other skilled rehabilitation services. As a practical matter, this can only be provided in a skilled nursing home facility on an inpatient basis.
For each spell of illness in 2019, Medicare Part A will pay all the costs for a covered skilled nursing home stay for the first 20 days. After that, it will cover all but $170.50 per day for up to an additional 80 days as long as all of the following conditions are met:
1. The individual was a patient in a hospital for three consecutive days, not including the day of discharge. In addition, the patient must be admitted to the skilled nursing facility within 30 days of discharge from the hospital. However, there are a few limited exceptions to the requirement that the admission must occur within 30 days of discharge from the hospital.
2. A doctor must certify that the patient needs skilled nursing home care.
3. The services are provided by or under the supervision of a trained individual.
4. The services are received on a daily basis, which means therapy services at least 5 days per week and/or nursing care 7 days per week.
5. The services are provided by a Medicare-certified skilled nursing facility.
6. The skilled services must be provided on an inpatient basis.
Remember, a Medicare beneficiary is entitled to receive coverage for all the skilled care in a nursing home for 20 days. A Medicare beneficiary is entitled to receive $170.50 of the cost of coverage for the next 20 days of skilled care in a nursing home. The Medicare beneficiary is not entitled to any coverage for skilled care in a nursing home beyond 100 days.
We know this raises questions for you. How will you be able to afford the skilled nursing facility bill? Where do you turn to for help? Should you ask your children to help? We want you to know that we are here to answer these questions. We work with Florida seniors and their loved ones each day as they handle these issues. Do not wait to contact our law office to schedule a meeting and find the answers you need.