Medicare is a wonderful program. It provides important health insurance for millions of older and disabled people. But, contrary to common belief, Medicare does not cover long-term care in skilled nursing facilities (often referred to as nursing homes).
In fact, at best, Medicare only covers up to 100 days of skilled nursing facility care per benefit period. To be covered by Medicare, the patient must need and receive daily skilled nursing and/or therapy. It's not unusual for people to be told they don't meet this standard, even when they do. If the individual is receiving daily nursing, physical, speech, and/or occupational therapy, she should consider appealing for Medicare coverage.
In addition, Medicare only covers a nursing home stay if the stay was preceded by an inpatient hospital admission of at least three consecutive days. This prior hospital requirement is increasingly difficult to satisfy since so many hospital stays are now characterized as "outpatient" observation status, not inpatient admission. This policy is further, and unfairly, limiting the Medicare benefit for skilled nursing facility care.
If the patient can be cared for at home, Medicare home health coverage may be available for nursing, therapy and home health aides for as long as the individual meets coverage criteria. These include the general inability to leave home, or only occasionally or for certain specified reasons. Unlike the skilled nursing facility benefit, when the coverage criteria are met, Medicare home health coverage is not limited to a set number of days (see Insight 10. Medicare Helps Older and Disabled People Stay Home).