Medicare Co-payment Has Increased for Nursing Home Residents

elderly man in nursing home

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.