Medicare Part A
Medicare will not cover room and board in a nursing facility unless the following conditions are met:
- Resident must have Part A Medicare coverage.
- Resident must have a qualifying hospital stay (3 or more days within past 30 days as required by Medicare).
- Resident must have a condition, which requires continued skilled care (i.e unstable medical condition, receiving intense therapy services and showing significant progress).
- Resident must be in a Medicare Certified Bed.
Provided the resident continues to meet all of the above criteria, Medicare Part A coverage can last up to 100 days. If the conditions are met, the first 20 days should be covered 100% by Medicare Part A (room, board, medications and therapy). During the remaining 80 days (if criteria are met), there is a co-insurance determined annually by Medicare. The Medicare Part A co-insurance is often covered by supplemental insurance.
Any remaining costs must be paid through private insurance, Medicaid or self pay.
Medicare Part B
Medicare Part B does not cover room, board or medications. However, Medicare Part B covers a limited number of services including physician visits. Lab work, x-rays and approved therapy services can be covered by Medicare Part B (often for long term care residents not currently covered under Part A). Medicare Part B covers 80% of allowable charges (after the deductible is met) for the above services. The remaining 20% is often covered by Medicare supplements, Medicaid, or private insurance. Any amounts not covered would be the responsibility of the resident.
Additional information on Medicare can be found at: www.medicare.gov