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

That is a good question. Unfortunately, it appears, 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 §10.4.3.2 below.” Here’s a link to the entire document: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/ge101c03.pdf

For more on Medicare’s limited nursing home coverage, click here.