Will Medicare Pay for a Second Stay in a Nursing Home After the Resident Pays Privately for 60 Days?

My mom was in a nursing home for 100 days. She got out of the nursing home, but two weeks later she is back in the hospital with breathing problems. She can't go home because she needs to get stronger, but if she goes back to a nursing home, Medicare won't pay because she has not been out of one for 60 days. If we pay for the 60 days in a nursing home ourselves, will Medicare pay for another 100 days after that?

That is a good question. Unfortunately, as far as I can tell, as long as your mother is in the skilled nursing facility, she cannot trigger the 60-day break in in-patient status necessary to start a new spell of illness even though Medicare is not paying for her care. The Centers for Medicare and Medicaid Services provides that “a benefit period cannot end while a beneficiary is an inpatient (see §10.4.4) of an institution that meets the basic definition of a “SNF” at §1819(a)(1) of the Act, as discussed further in § below.” Here’s a link to the entire document: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/ge101c03.pdf

Categories: Medicare