If you require rehabilitation or therapy in a nursing home facility, then Medicare may provide some assistance to you, at least for the first several months. According to federal law, Medicare will cover your skilled nursing care in a facility as long as certain requirements are met. For example, you must have been receiving care in a hospital for at least three consecutive days immediately prior to your admission into the nursing home facility for care. In addition, your care in the facility must be considered “skilled” rather than “custodial”.
If a person requires help with activities of daily living rather than medical care, then that care may be considered custodial. Medicare does not provide coverage for custodial care. On the other hand, if a person requires rehabilitation, physical therapy and/or occupational therapy, then that care may be considered skilled, which is covered by Medicare.
According to federal law, Medicare will provide payment in full for the first 20 days and then a portion of the remaining 80 days. A federal regulation provides that there must be a daily co-payment equal to one-eighth of the hospital deductible amount. Pursuant to this law, there was a daily co-payment of $170.50 for the 80 day period of time in 2019. This daily co-payment, however, has increased effective January 1, 2020.
Effective January 2020, the daily co-payment for care in a skilled nursing facility is $176.00. Unless there is adequate coverage through supplemental health insurance, an individual who requires skilled care in a facility and receives payment from Medicare will still have an outstanding balance owed of $14,080.00 for a stay in a facility of 100 days.
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