The benefit period ends when you haven't received any type of hospital care (or up to 100 days of specialized care in an SNF) for 60 consecutive days. If you are admitted to a long-term care facility, Medicare Part A can pay for the medical services of a long-term care facility for up to 100 days. After this period, Medicare may continue to be used to cover certain treatments, such as occupational therapy, speech therapy, or speech-language disorders. However, Medicare won't cover room and board after 100 days.
If the nursing home tells you that therapy will be interrupted due to the resident's “stagnation” or lack of progress and that Medicare won't pay, you can ask the nursing home to submit a bill to Medicare (this is known as a “demand bill”). As with any other illness, coverage for stays in a nursing home or skilled nursing facility is generally limited to 100 days. The nursing home may say that Medicare will no longer pay for therapy because the resident is not getting better. While long-term care coverage in nursing homes is limited, Medicare provides other important benefits to nursing home residents. If you or someone you know is considering nursing home care, make sure you fully understand what services Medicare does and doesn't pay for.
Nursing homes provide a safe alternative for older adults who need high-level, long-term care beyond what assisted living can provide. Medicare payment for care in a skilled nursing facility requires hospitalization of the patient for 3 days immediately prior to admission to the nursing home. Also known as skilled nursing facilities, nursing homes provide ongoing medical care and personal care services to people who need that support and can't get it in the home. Sometimes, a nursing home may say that therapy must be stopped because Medicare won't pay for the therapy because the resident has “stalled” or is no longer improving or progressing.
Be sure to visit the NCOA BenefitsCheckUp to look for other benefit programs that can help you pay for health care, food, prescription drugs, utilities and other basic living costs. For some people, staying in a nursing home is temporary; for example, they have been discharged for short-term care after hospitalization or surgery and need a little extra help to recover. Remember that you may once again be entitled to Medicare coverage for the care you receive from the SNF once you have been out of the hospital or the SNF for 60 consecutive days. And Medicare members who are permanent residents of nursing homes “can certainly use their health care benefits for their intended purpose,” Newsholme said.
Ask your provider if you are eligible for home treatment through the Medicare home health benefit, or if you can be treated safely as an outpatient. An outpatient is a patient who has not been formally admitted to the hospital as an inpatient.
