Medicare's Strict Limits

Most people mistakenly believe that Medicare will cover the cost of Long Term Care. The reality is that Medicare only covers nursing home costs for a very short period of time following a hospital stay to recuperate from an acute ilness or injury.

Medicare is a program that pays limited health care costs for people who are over 65 years old or who are disabled. Many people mistakenly believe Medicare will pay for their Long Term Care. In fact, Medicare covers few Long Term Care services.

Medicare plays a small role in funding Long Term Care because of strict eligibility and coverage limits. To qualify for Medicare, patients must meet the following conditions or requirements:

• Medicare coverage for patients in skilled nursing facilities is limited to 100 days.
  
  
• To qualify for Medicare payments one needs to have been in a hospital for 3 days consecutively and enter a skilled nursing facility within 30 days of the hospitalization.
  
  
• 20 days of full coverage, plus an additional 80 days of partial or co-insurance coverage.
  
  
• In days 21-100, patients (in 2001) must pay $99.00 per day to continue receiving Medicare payments.

After 100 days, when Medicare runs out completely, all too often nursing home residents and their families find that care must be financed with personal savings or assets until the resident becomes poor enough to qualify for state assistance through the Medicaid program.

Medicare's Skilled Nursing Care Conditions

For Medicare to cover skilled nursing care, patients must meet ALL of the following five conditions:

• the patient's condition requires daily skilled care, not merely custodial or basic care
  
  
• the patient has been hospitalized at least three days in a row
  
  
• the patient is admitted to a skilled nursing facility within 30 days of leaving the hospital
  
  
• the patient's care in the skilled nursing facility is for a condition that was treated in the hospital
  
  
• and a physician certified that the patient needs, and has received skilled nursing services daily since his or her admission to the hospital

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