Medicare Part A
This portion of the Medicare program pays for both hospitalization and some nursing home care.
Nursing Home coverage is provided if you meet strict medical criteria, i.e. daily skilled care as well as what other criteria? You must be hospitalized three consecutive days (the day of discharge is not counted) within the last 30 days prior to admission to a skilled facility.The physician must verify that your treatment and intensity of care meets the Medicare criteria for skilled nursing home care. The Medicare Utilization Review Committee must verify your need for skilled care both before and after admission.
If I meet the above criteria, what type of coverage am I eligible for? If you meet the above criteria and are admitted to a nursing home, you may be eligible for up to 100 days of coverage available under the Medicare program. The Medicare program will pay the full cost of your first 20 days in a nursing home. The next 80 days, you will be responsible for a daily rate of $164.50/day for the nursing care in a semiprivate room with Medicare making up the difference. This rate usually increases each year on January 1.
What services are provided under Medicare Part A? While you are in a nursing home under Medicare Part A, the following services are covered:
- semiprivate room
- pharmaceutical/ medical supplies
- physical, occupational and speech therapies
- routine nursing care
When is Medicare coverage discontinued? If you stop receiving skilled care or if you fail to make progress from the skilled nursing care being given, the Medicare Utilization Review Committee may discontinue your Medicare coverage in the nursing home. This is not the nursing home's decision. The decision is made by the Medicare Utilization Review Committee.
