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Does Medicare Or Medicaid Pay For Nursing Care?


When certain conditions are met, Medicare and Medicaid can, and will, pay for a patient’s nursing care. Being aware of these conditions, and speaking with a long-term care planning lawyer, will make it easier to obtain nursing care through Medicare and/or Medicaid. 

Does Medicare Or Medicaid Pay For Nursing Care? 

The answer to the question above is “It depends.” Sometimes, Medicare/Medicaid will pay for nursing care. And, other times, it will not pay for nursing care.

Being aware of the conditions that allow Medicare to be used for nursing care will make it easier to find nursing care that aligns with one’s Medicare. The same is true for Medicaid.

Right before we begin, though, it is worth noting that the conditions allowing Medicare and Medicaid to be used for nursing care are rather strict. For this reason, it is often wise to look into other options.

When Does Medicare Pay For Nursing Care? 

A variety of conditions must be present, in order for Medicare to pay for nursing care. The conditions that must exist, in order for Medicare to be used to pay for nursing care, are as follows:

  • The nursing care is considered skilled nursing care.
  • The nursing care lasts for a period of no more than one-hundred days.
  • On the 21st day of their care, the patient must begin paying a co-payment equal to one-eighth of the initial hospital deductible cost
  • The patient must have been hospitalized for at least three-days, prior to being admitted into skilled nursing care.
  • While going through skilled nursing care, the patient must be dealing with the same problem that they were hospitalized for.
  • The patient must begin their period of skilled nursing care no more than thirty-days after being admitted to leave the hospital.

Outside of those conditions, if a patient was classified as being on “observation” during their hospital stay, then Medicare cannot be used to pay for the skilled nursing that resulted from this period.

When Does Medicaid Pay For Nursing Care? 

Just like Medicare, there are certain conditions that must be met, in order for Medicaid to pay for nursing care. And, within this context, Medicaid can only pay for long-term nursing care.

Right before we go over the conditions that allow Medicaid to be used for long-term nursing care, a key fact must be clarified: long-term nursing care is not meant to heal, it is meant to provide care.

For the reason outlined above, long-term nursing care is considered custodial care and, as such, Medicaid can pay for it. But, only if the following conditions are met:

  • The patient must have no more than $2,000 in countable assets.
  • The patient must abide by a five-year look-back period, allowing the state of Florida to examine their expenditures, including any sizable gifts.
  • The patient’s gross monthly income must not exceed $2,742.

Other conditions exist, but these are the most significant. A patient who does not meet these conditions will not be eligible for nursing care that is paid for through Medicaid.

Contact A Florida Long-Term Care Planning Lawyer Today 

Even though it isn’t always possible for Medicare/Medicaid to pay for your nursing care, if you meet the conditions outlined within this essay, then they will do so.

Contact a Florida long-term care planning lawyer today and we will assist you in determining whether or not you meet the necessary conditions and, if so, how to obtain the nursing care you need.  Call the Millhorn Elder Law Planning Group today




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