Medicare coverage doesn't end when a person goes to a nursing home, but it does have some limits. Medicare will continue to cover anything necessary for the person's medical needs. It won't pay for a person's custodial care, as help with eating, dressing and bathing is not considered a medical need.
Medicare will cover a stay in a certified skilled nursing facility when there is a medical necessity for it. It will cover medicine and services designed to prevent, treat or diagnose a disease or injury. The nursing home can bill the patient's Medicare when it changes his sterile dressings, maintains his oxygen or IV fluids or when it provides supplies such as walkers and wheelchairs.
Medicare will only consider coverage for nursing home care after a person has had a three-day hospital visit. The patient must enter the facility within 30 days of the stay, and it has to be a facility approved to take Medicare. Medicare pays 100 percent of the costs for the first 20 days. A coinsurance is required for days 21 through 100, which is the extent of the coverage. A person's coverage can be eliminated if she refuses treatment while in the home.
Medicare Part D will continue to pay for medications when a person is in a nursing home. The nursing home will contract with a long-term care pharmacy that works with Medicare insurance to fill the prescriptions. Part A covers medications for people in a nursing home for rehabilitation and skilled nursing care.
Medicare will cover most of a person's nursing home expenses. A semi-private room is one such expense. It will also cover meals, medical supplies and nursing care, as well as dietary counselling and ambulance services. If it's necessary for recuperation, Medicare also covers physical and occupational therapy and speech pathology services in the nursing home.