Many persons believe that Medicare pays for the nursing home care, but actually Medicare coverage is extremely limited. There must be a qualifying hospitalization and skilled nursing care must be required. Part A covers up to 100 days in a skilled nursing facility per illness. At least a 60 day period must have elapsed from a previous inpatient stay. Personal care services are not considered skilled services except under certain conditions. Most nursing home residents do not require skilled care and even if they do, Medicare only pays the first 20 days in full and only part of the next 80 days of the 100 day maximum: the patient must pay the balance of $128/day co-pay, but if at any point during the 100 days of coverage, a determination is made that the resident does not need skilled care, Medicare coverage ends.
Since only about 13% of nursing home residents need skilled care, costs must be paid through either personal funds or through Medicaid.