Nursing Home Abuse Report » Resources Overview » Medicare Eligibility

Medicare Eligibility for Nursing Home and Nursing Care

Medicare does not generally pay for long term care. It only pays for medically necessary skilled nursing facility or home health care. Medicare will cover nursing home care only if the patient receiving the care needs the highest level of care, called skilled nursing. The patient must also have spent at least three consecutive days in a hospital not more than 30 days prior to nursing home admission. A physician must certify that skilled nursing services are needed for the same or related illness for which the patient was hospitalized.

Medicare will pay the cost of the following:

• A semi-private room
• Meals, including special diets
• Regular nursing services
• Rehabilitation services
• Activities programs
• Medically-related social services
• Basic haircuts
• Certain over-the-counter medications furnished by the facility
• Facility maintenance
• Personal laundry
• Routine personal hygiene items
• Certain medical supplies

You must meet these conditions for Medicare to help pay for your care in a nursing home:

• You need to have been in the hospital for three or more days before you go to a skilled nursing home.
• Your care must begin within 30 days after you leave the hospital.
• Your doctor must order daily skilled nursing or rehabilitation services that you can get only in a skilled nursing home.
• You get these skilled services in a nursing home that has been approved by Medicare.

If you meet these conditions, Medicare pays for up to 100 days in a benefit period. A benefit period begins the day you go into the hospital or skilled nursing home. The benefit period ends when you have been out of the hospital or skilled nursing home for at least 60 days in a row. You pay a Part A deductible ($1,024 in 2008) for each new benefit period.