If a person requires skilled care pursuant to the federal Medicare statute and is in a nursing home facility, then Medicare will pay a portion of that care in the facility. Medicare will pay for the first 20 days of skilled care. Medicare will pay for a portion of the remaining 80 days but according to applicable federal law, there is a co-payment equal to one-eighth of the hospital deductible amount.
In 2021 the daily co-payment was $185.50 for the 80 day period. This year the daily co-payment is $194.50. Therefore, if an individual requires skilled care in a facility and it is covered by Medicare, then the total amount owed to the facility for the first 100 days should be $15,560.00.
Often supplemental health insurance will cover the co-payment. If your supplemental health insurance provides coverage for the co-payment, then there should not be an obligation due and owing to the facility for the first 100 days.
In light of the public health emergency caused by the COVID-19 virus, Medicare is extending coverage beyond the first 100 days of skilled care. There is currently a debate as to whether or not the additional coverage must be related to COVID-19.
Law Office of Donald B. Mark 