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Medicare.gov provides several tools and suggestions to help you find a nursing home that accepts Medicare in your area. If you are looking for a nursing home for yourself or a loved one, here are some ways to get started finding the right one for your needs.
When does Medicare cover nursing home care?
There are very specific situations in which Medicare covers care in a nursing home, and there is a limit to the number of days of nursing home care it will cover.
Generally in order to be eligible for coverage under Medicare Part A, you must have completed a qualifying hospital stay of at least three full days and meet all of the following conditions:
- You have days left in your benefit period (typically up to 100 days).
- Your doctor believes it is medically necessary that you get skilled nursing home care to treat your condition (custodial care isn’t covered).
- You had the condition you need care for when you were in the hospital during a qualifying stay, or the condition developed while you were in the hospital.
- The nursing home you choose is certified by Medicare.
If you have questions about whether Medicare will cover your nursing home care, be sure to talk to your doctor or the admissions director at the nursing home.
How can I find a nursing home that accepts Medicare?
Medicare.gov has compiled a Nursing Home Compare database with information about every Medicare-certified nursing home in the country. You can enter your location (or the location where you’re looking for a nursing home) and get a list of all approved facilities in that area. You can also download the Nursing Home Compare data set that helps you compare the quality of all Medicare-eligible nursing homes.
Medicare uses a 5-star system to rate a nursing home, which includes an overall rating based on the following criteria:
- Health inspections based on the three most recent annual inspections.
- Staffing, which includes the number of RNs, LPNs, and certified nursing assistants among other factors.
- Quality measures based on resident assessment data with residents reporting how well the facility meets their needs.
This information can give you a snapshot into some basic information about the nursing home you are considering. Medicare also recommends that you contact the Long-Term Care Ombudsman in your area for answers to questions such as:
- Whether the nursing home has had any complaints and if so, what the nature of those complaints were.
- How a particular nursing home compares with others you may be considering.
- If there are any strengths or weaknesses you should be aware of.
Medicare also suggests that you contact your state health department for information about the quality of care the nursing home provides. If possible you or someone you trust should also visit the facility before you make a decision.
Where can I find more information about Medicare and nursing home care?
The Centers for Medicare and Medicaid Services (CMS) has prepared a detailed booklet with information for Medicare enrollees who need nursing home care. It includes information about your benefits under Medicare as well as your rights if you are a nursing home resident and what to do if you have a question or complaint.