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Taking the mystery out of Medicare

This is a commonly asked Medicare question.

Q: My spouse needs to go to a nursing home. Will Medicare pay for it? Can Medicare help me select a nursing home that will provide high quality care?

A: Medicare Part A pays for short-term stays in a nursing home, if it is needed after an inpatient hospital stay of at least three days. This usually means skilled nursing home services are required for rehabilitation after an injury, disability or illness. If this is the case and the person needing the skilled nursing care has Medicare Part A and has a doctor’s order for skilled nursing services, the first 20 days in the nursing home are paid completely by Medicare. The next 80 days in the nursing home requires a payment by the person with Medicare of $148 per day in 2013. After 100 days, Medicare will no longer pay any portion of the stay.

Medicare does not pay for long-term care. And Medicare won’t pay for any skilled short-term care unless it immediately follows, and is directly related to, an inpatient hospital stay.

Medicare provides a great deal of information for you about nursing homes, to help you select one that will provide quality care. Simply go to www.medicare.gov and click on “Find a Nursing Home” on the home page. You can search by name, or by location.

Medicare’s Nursing Home Compare listings show quality of care information on every Medicare and Medicaid-certified nursing home in the country — over 15,000 facilities. Note that facilities not certified to participate in Medicare or Medicaid are not listed, but are regulated by your state, which may publish its own information.

On www.medicare.gov, you can see information about recent health inspections, staffing information and summaries of recent deficiencies. You can also see how an individual facility rates on the CMS Five-Star Quality Rating. In a few cases, you also see a facility marked with an “SFF” icon. SFF stands for “Special Focus Facility.” This means the nursing home has a recent history of poor quality and will be surveyed (inspected) twice as often as nursing homes without this designation. However, it’s worth noting that many facilities in the SFF program significantly improve their performance, which is the goal.

Information on Nursing Home Compare is something you should consider carefully, but not alone. Talk to your doctor or other health care provider about this information. In many cases, some categories of performance may matter to you more than others. CMS does not endorse any nursing home, even the ones with good star ratings, and you shouldn’t rely only on the ratings to make this important decision. The most important thing you can do is to visit the facilities you are considering, to get a first-hand feel for how they operate. Talk to the staff, and to people who live there. If you can’t visit, have someone you trust do that for you.

As always, for more information about any Medicare questions, call (800) 633-4227. Customer service representatives are available 24 hours a day, 7 days a week.

This story was posted on May 23, 2013.