If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered.
The care being rendered by the nursing home must be skilled. Medicare part A does not pay stays which only provide custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc.
The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment of $161 per day as of 2016. Many insurance companies have a provision for skilled nursing care in the policies they sell.
If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 90-day hospital clock and 100-day nursing home clock are reset and the person qualifies for new benefit periods.
Hospice benefits are also provided under Part A of Medicare for terminally ill persons with less than six months to live, as determined by the patient’s physician. The terminally ill person must sign a statement that hospice care has been chosen over other Medicare-covered benefits, (e.g. assisted living or hospital care). Treatment provided includes pharmaceutical products for symptom control and pain relief as well as other services not otherwise covered by Medicare such as grief counselling. Hospice is covered 100% with no co-pay or deductible by Medicare Part A except that patients are responsible for a co-pay for outpatient drugs and respite care, if needed.
As of 01/01/2015, the Medicare Part A has an inpatient hospital deductible of $1260, coinsurance per day as $315, coinsurance of life time reserve as $630, and coinsurance of Skilled Nursing Family as $157.50.