Specialized Information for:

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Preserving Medicare's Role in Long-Term Care

Although Medicare coverage for long-term services and supports is very limited (the program accounts for roughly 12% of all long-term care spending in our nation), the Medicare program still plays an important role in providing consumers access to certain needed services and therapies. For example, for Medicare beneficiaries with a prior hospital stay (which meets the three-day, inpatient requirement set by the Centers for Medicare and Medicaid Services), Medicare will cover skilled nursing care and rehabilitative therapy services in a nursing home for a maximum of 100 days. Medicare will cover the full cost of nursing home care for the first 20 days and then beneficiaries will be charged a limited co-pay for up to 80 remaining days of needed care. Beneficiaries that are admitted to a hospital under observation status cannot qualify for Medicare coverage for these services. This a significant issue, as more and more long-term care consumers are being admitted into the hospital under observation status and not as inpatients. For more information, please view the resources and links below.

Additionally, Medicare covers home health services for certain beneficiaries with skilled care needs. To qualify, beneficiaries must be homebound and have confirmation from their physician that they require intermittent skilled nursing and therapy services.

Many long-term care consumers are reliant upon Medicare to cover these limited but crucial services. Any funding reductions or structural changes made to the Medicare program could limit consumer access to needed care or increase out-of-pocket costs for beneficiaries.

For more information on Medicare coverage of skilled nursing facility care, click here.

For more information on Medicare coverage of home health services, click here.

Medicare also provides benefits for hospice care; you can read more here.

Consumer Voice Resources

Other Medicare Resources and Links

Observation Status Resources and Links