Medicare and Nursing Home Care in North Carolina

Cary NC Elder Law Attorney
A common question I hear from clients and colleagues is: “Doesn’t Medicare pay for skilled nursing or nursing home care in North Carolina?” It seems like it should, right? Medicare is primarily a health insurance program for retired and elderly individuals. Skilled nursing and nursing home care is generally needed by elderly individuals. It would make sense that Medicare should pay for nursing home care. Well, when it comes to long-term care in a nursing home, Medicare just doesn’t cover it – at least not all of it.

What Does Medicare Cover?

Medicare will pay for rehabilitation care in a skilled nursing facility if a Medicare recipient spends at least three (3) days in a hospital and then is transferred to a skilled nursing facility for rehabilitation care. But Medicare will only pay for such care as long as the Medicare recipient’s condition is improving during their stay, and only for a maximum of 100 days. Yes, ONLY 100 days. After that, Medicare coverage stops and the recipient must either magically be better, private pay, or have some other means of paying for treatment (i.e., Medicaid coverage, generous relatives, or a long-term care insurance policy).

It Gets Worse

While Medicare will pay for up to 100 days of treatment in a skilled nursing facility under the circumstances listed above, it will only pay the full amount for the first 20 days of treatment. After that, there is a deductible of $164.50 per day from Days 21-100. That means a person can be required to pay over $13,000 over and above what Medicare will cover during those 100 days.

Medicare supplemental insurance can help to cover most if not all of that difference, though.