Medicare and Skilled Care

Demographics

According to the 2020 U.S Census, people aged 65 and over comprise 16.8% of the country’s population.

70% of people currently age 65 or older will need some kind of long-term care, according to the federal government.

However, there are only 1.7 million nursing home beds in 15,600 facilities, according to the Centers for Disease Control and Prevention.

Medicare is a form of health insurance, it’s not meant to cover housing and food costs or long-term stays in a nursing facility. Medicare may pay 100% for the first 20 days for people who need skilled nursing care and 80% for up to 80 days. This includes medical care, physical and occupational therapy and other services. Medicare will cover a maximum of 100 days of skilled nursing care.

Skilled nursing provides complex care and rehabilitation for people who have had a stroke, surgery or extensive treatment for kidney, heart or respiratory conditions and may need rehabilitation after their release from a hospital stay.

Qualifying Criteria

Medicare does pay for skilled nursing care only for individuals who qualify though. According to medicare.gov, you may qualify for Medicare part A (hospital insurance) coverage for skilled nursing care if a physician determines you need daily skilled nursing care; you’ve had a hospital stay of at least three days (not including the day you leave the hospital); you need skilled nursing services for a hospital-related medical condition.

Long-term care is often provided by nursing homes. Nursing homes must provide residents with 24 hour care for pre-existing conditions such as stroke or dementia. People who have conditions that compromise the activities of daily living.