Medicare Info

This page is meant to be an educational guide for those looking into nursing home and rehab services. The world of Medicare, Medicaid, and Long-Term Care Insurance can be tricky to understand, even more so to navigate aloneWe invite you to call us at (309) 636-3600 regarding your personal situation to see how we can help.

Medicare is one of the most frequent methods of paying for short term nursing home care. Medicare is a federal health insurance program which helps defray many of the medical expenses of most Americans over the age of 65. Medicare offers a rehabilitation benefit in order to help people transition from a medical event back to their home. Heddington Oaks prides itself in their Rehab to Home program, helping people recover from a joint replacement or other ailment and getting back to their daily lives at home.

Many people assume that Medicare or their insurance will pay for long-term nursing home care. Unfortunately, this is usually not the case. Medicare pays for no more than the first 100 days of nursing home care, and it has many other restrictions so that many people entering a home almost never receive full benefits. Most residents' health care insurance stops when Medicare coverage stops. Unless your loved-one has unusually good long term care insurance, the are likely to end up paying for her nursing home care out of her own pocket or with Medicaid.

While at a skilled-nursing facility under traditional Medicare, the first 20 days are covered 100%. Starting on the 21st day through a possible 100 days, Medicare will pay 80% of the cost of care, and the patient is responsible for 20%. In 2018, the 20% co-insurance amount per day was $167.50. This may vary if you have a Medicare Replacement or Supplement Plan.

For more information on Medicare, visit www.medicare.gov.

What Medicare Pays For

For Medicare to pay for any part of your loved-one's nursing home care, they must:

  • have been hospitalized (this does not mean "kept in observation") for at least 3 days; and
  • go into a nursing home that is in the Medicare program, no more than 30 days after leaving the hospital; and
  • need nursing home care for the same reason as the hospitalization; and
  • need what Medicare calls "skilled care."

Medicare pays for part or all of up to 100 days a year of what it calls "skilled care." What Medicare means by "skilled care" is the person:

  • is on oxygen; or
  • has an IV or feeding tube; or
  • needs daily injections, daily wound care or other skilled care; 
  • needs daily physical, occupational or speech therapy. Medicare is supposed to pay for daily therapy care, either to improve or maintain ability to function; or
  • has a medical condition that is so unstable that they need to be monitored by a registered nurse. For example, they might be on a new medication and need to have daily blood tests for the doctor to decide on the right dosage, or have their condition closely watched to make sure the medication is not harming them, or need their blood sugar levels monitored.

Medicare will pay for your doctor visits, and care by other medical professionals such as a podiatrist. 

Medicare has copayments and deductibles for some days of care for which it pays.

Medicare Part B

Part B Medicare will also pay for some physical, occupational and speech therapy for nursing home residents, including residents whose daily care is not being paid for by Medicare. Part B is not supposed to pay for therapy which is covered as part of the daily nursing home rate.