Today we tackle one of the most common questions about Medicare: Does Medicare pay for nursing home care? In this blog post, we give you an answer, along with all the information you need to know about this topic.
Does Medicare Pay for Nursing Home Care?
The short answer to this commonly asked question is that original Medicare doesn’t cover most nursing home care.
Medicare only covers limited (and medically necessary) skilled care at a nursing home or in your home if you need skilled, short-term care.
Here, it’s important to draw a distinction between two types of care:
- Custodial care. Means a place that offers help with the activities of daily living (such as bathing or eating). Most nursing home care is custodial care, and is not covered by Medicare in most cases if it’s the only type of care you need.
- Skilled nursing facility (SNF) care. This is healthcare provided when you need skilled nursing or therapy staff to treat, manage, or evaluate your care. Under certain circumstances, Medicare can cover this type of care.
You may get SNF care for a limited time (see below) if all the following conditions apply:
- You have Part A and have days left in your benefit period to use.
- You have a qualifying inpatient hospital stay.
- Your doctor has decided that you need daily skilled care.
- You get these skilled services in a Medicare-certified SNF.
- You need these skilled services for a medical condition that’s either a hospital-related medical condition or a condition that started while you were getting care in the SNF for a hospital-related medical condition.
Here’s how much Medicare covers for qualifying SNF care:
- Days 1 to 20: Medicare pays the full cost for covered services.
- Days 21 to 100: Medicare covers all but a daily coinsurance, which you pay.
- Days beyond 100: Medicare pays nothing; you pay the full cost.
If you need nursing home care and have a Medicare Advantage plan (part C), your plan may cover it. However, plans don’t help pay for this type of care unless the nursing home has a contract with the plan, so make sure to check with your plan to understand what their situation is.
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