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Quick GuideA Caregiver's Guide to Alzheimer's Disease

A Caregiver's Guide to Alzheimer's Disease

Medicare Coverage of Skilled Nursing Care Facilities

In order to receive care in a nursing home under Medicare:

  • You must have had a three-day hospital stay prior to admission into the skilled nursing facility.

  • You must be admitted into the skilled nursing facility within 30 days of discharge from the hospital.

  • You must enter the skilled nursing facility for treatment of the same condition for which you were hospitalized.

  • You must require daily skilled care.

  • The condition must be one that can be improved by admission to the facility.

  • The facility must be Medicare-certified.

  • Your physician must write a care plan. The care plan must be carried out by the skilled nursing facility. (Once the patient meets the level of functioning laid out in the care plan, Medicare will no longer pay for services.)

Medicare Coverage of Home Care

In order to receive home care under Medicare:

  • The patient must be homebound.

  • The physician must certify a plan of care.

  • Care must be needed on a non-continuous basis.

  • Care cannot exceed 35 hours per week or 8 hours per day.

  • Physical or speech therapy must be provided on a "necessary and reasonable" basis. There are no restrictions on the number of days or hours per week of these therapies.

  • If a person qualifies for home health care, he or she is entitled to a home health aide to provide some personal care.

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