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Does medicare pay for nursing homes?

If custodial care is all you need, Medicare may not cover it

Profile picture of Danni White
by Danni White ConsumerAffairs Research Team
nurse helping woman with walker

Medicare offers pretty limited coverage for nursing home care, but it can help offset the costs of a short-term stay or related medical services. If what Medicare offers isn’t enough, you have other options, though. Read on to see what Medicare can do for you and what your alternatives are if you need more help.

What parts of nursing home care does Medicare cover?

Medicare covers up to 100 days at a skilled nursing facility.

Medicare Part A and Part B cover skilled nursing facility stays of up to 100 days for older people who require care from people with medical skills, such as sterile bandage changes. Medicare does not otherwise cover the costs of long-term stays in nursing homes because most nursing home care is considered custodial care. However, it can cover short-term care in a skilled nursing facility if you meet the requirements. Some of the specific things covered by Medicare include:

  • A semiprivate room
  • Meals
  • Skilled nursing care
  • Physical and occupational therapy
  • Medical social services
  • Medications
  • Medical supplies and equipment

However, if you have a Medicare Advantage Plan, it’s possible that the plan covers nursing home care. Likewise, Medicare supplemental insurance may cover some associated costs. If you have Medicare drug coverage (Part D) or a Medicare Advantage Plan with drug coverage, you can get coverage for prescriptions from a long-term care facility pharmacy that works with your plan.

Medicare also has a strict list of requirements you must meet to qualify, including:

  • Having Medicare Part A coverage
  • Having days left in your benefit period
  • Having a qualifying hospital stay of three inpatient days
  • Your doctor determining that you need daily skilled care
  • Getting these services at a Medicare-certified skilled nursing facility
  • Needing skilled care for a medical condition that is either:
    • A hospital-related condition treated during your inpatient stay, even if it wasn’t the reason you were first admitted
    • A condition that started while you were already getting care in a skilled nursing facility for a hospital-related condition

What parts of nursing home care does Medicare not cover?

Medicare doesn’t cover most aspects of nursing home care. This includes custodial needs, such as bathing, eating or moving around. It also doesn’t cover room and board for any long-term nursing home stay, including hospice care or the cost of a private room. Lastly, Medicare won’t cover your skilled nursing facility stay if it’s not in an approved facility, so it’s important to know what institutions it has approved in your area.

FAQ

How long can you stay in a nursing home with Medicare?
Medicare covers a stay in a skilled nursing facility for up to 100 days.
Does Medicare cover nursing home care for dementia?
Medicare only ever covers the first 100 days in a nursing home, so nursing home coverage is not significantly different for people with dementia. Medicaid can help cover memory care units and nursing home stays beyond 100 days, though.
Can older people rely on Medicare to cover nursing home costs?
No, older adults should not rely on Medicare to cover nursing home costs. While Medicare can help offset some costs, such as doctor visits or medication, it will not cover long-term stays at a nursing home. For that, they will have to consider some of the alternatives listed below.
How many days does Medicare pay for a skilled nursing facility?
Medicare caps coverage for a skilled nursing facility at 100 days. Any charges for time beyond that are the responsibility of the patient.

Other ways to pay for nursing home care

Even though needing nursing home care is not a guarantee, it’s important to plan for, just in case. While Medicare doesn’t offer a lot of support for long-term stays in nursing facilities, other options are available, depending on your history, financial situation and other qualifications.

Long-term care insurance

Similar to regular health insurance, long-term care insurance has you pay a premium in exchange for financial assistance should you ever need long-term care. This insurance can help prevent you from emptying your savings if you suddenly find yourself needing nursing home care. However, it’s important to note that these policies often have a daily or lifetime cap for the amount paid out. When you apply, you can choose an amount of coverage that works for you.

With most policies, you’re eligible for nursing home care if you can’t perform two of the six activities of daily living, which are:

  • Bathing
  • Eating
  • Getting dressed
  • Grooming
  • Toilet hygiene
  • Functional mobility

Your policy’s cost will depend on your age, gender, health, marital status, and the amount of coverage you choose. Most policies will also require you to pay out of pocket for a predetermined amount of time, usually between 30 and 90 days, before coverage kicks in.

Personal funds

You can also pay for nursing home care with personal savings, a retirement fund, a pension or any number of other sources. According to Medicare.gov, some insurance companies even allow you to use your life insurance policy to help pay for long-term care. However, paying out of pocket may not be the best way for you to cover the cost of nursing home care.

On average, annual costs for nursing homes fall between $90,000 and $110,000, depending on whether you have a private or semi-private room. This can burn through your personal funds surprisingly quickly. It’s best to pair your personal funds with other financial aid to help you afford nursing home care.

Medicaid

Medicaid covers long-term care in certified facilities, including:

  • Nursing services
  • Specialized rehabilitative services
  • Pharmaceutical services
  • Individualized dietary services
  • Emergency dental services
  • Room and bed maintenance services
  • Routine personal hygiene items and services

However, there are some perks and services that Medicaid does not pay for, including:

  • A private room (unless medically necessary)
  • Telephone, television and radio
  • Personal comfort items (for example, cigarettes)
  • Personal clothing
  • Reading material
  • Specialty foods

Qualifications for covered nursing home care vary by state, though. Unlike Medicare, which is managed federally, Medicaid is managed by the states and based on income.

VA benefits

Veterans can qualify for long-term coverage through VA benefits. Long-term services offered by the Department of Veterans Affairs include:

  • 24/7 nursing and medical care
  • Physical therapy
  • Help with daily tasks
  • Pain management
Veterans can qualify for long-term care coverage through VA benefits."

If the service you need isn’t covered, the VA will help you to sign up for other helpful services, such as Medicaid.

To qualify for help, you need to be signed up for VA health care, deemed in need of the specific service and live near where the service is offered. Other factors may also be considered. The VA inspects and approves the facilities it works with, including nursing homes. These homes might be run by VA, the state or other community programs.

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Profile picture of Danni White
by Danni White ConsumerAffairs Research Team

As a member of the ConsumerAffairs research team, Danni White is committed to providing valuable resources designed to help consumers make informed purchase decisions. Danni specializes in content strategy and development, with over a decade of professional writing and research experience.