Does Medicare Pay for Nursing Homes?
Most nursing home care is not covered by Medicare, but medically necessary care may be covered
Reviewed by: Shikita Nunnery, Licensed Insurance Agent. Written by: Aaron Garcia.
If medically necessary, Medicare Part A may cover services in a Skilled Nursing Facility (SNF)
If you receive skilled nursing care, Medicare will pay for custodial services during your stay
If Medicare does cover your care because it’s medically necessary, keep in mind you’ll still have some out-of-pocket costs, including coinsurance and your deductible
A Medicare Supplement plan can help you with out-of-pocket costs like copays and deductible
Medicare doesn’t cover custodial care if it’s the only care you need. Most nursing home care is custodial care. But if you’re in a nursing home, you’ll still need Medicare for any hospital care, doctor services, and medical supplies you receive while there. Medicaid and long-term care insurance are non-Medicare options that may help cover some nursing home costs.
First, it’s essential to answer: What is a nursing home? Nursing home care falls under the category of custodial care. Custodial care helps you with daily living activities (bathing, dressing, using the bathroom, and eating) or personal needs. Most nursing home care is custodial care.
Does Medicare cover nursing homes?
Medicare doesn’t cover nursing homes. In some instances, Part A (hospital insurance) may cover care in a certified skilled nursing facility (SNF). Your care must be medically necessary for you to receive skilled nursing care.
Medicare will only cover care received in a nursing home if you receive skilled nursing services. In this case, Medicare will also cover the custodial care you receive as part of your stay. You’ll need to meet other requirements, and your doctor will have a big say in the matter—more on that below.
Medicare covers care in a skilled nursing facility up to 100 days per benefit period if you continue to meet the qualifications. Skilled nursing facility (SNF) care is health care given when you need skilled nursing or therapy staff to treat, manage, observe, and evaluate your care.
According to the American Council on Aging, the nationwide average daily cost for a shared room is $255. But make sure to check the actual options in your area because pricing can vary widely. For example, prices can range as low as $175 per day in rural Texas and more than $1,100 per day in parts of Alaska.
Those costs are associated with custodial care and are considered personal pay, which means Medicare won’t cover room and board for nursing homes. While Medicaid nursing home coverage may pay for room and board, it only covers shared rooms, not private rooms.
Does Medicare cover nursing home costs?
Medicare only covers skilled nursing care if you have a medically necessary reason, which usually must include a qualifying trip to a hospital. Typically, your level of care needed will influence the decision. If you can be cared for by a non-medical professional, Medicare probably won’t cover your nursing home costs.
If Medicare does cover your care because it’s medically necessary, keep in mind you’ll still have some out-of-pocket costs, including coinsurance and your deductible. These are typical costs associated with Original Medicare. To help pay for these, many Original Medicare enrollees also purchase Medicare Supplement Insurance (Medigap). These private policies can help cover your skilled nursing care received in a nursing home.
How to pay for nursing home?
Because nursing home care is private pay, residents must cover their costs themselves. That means you may consider retirement savings, private funds, social security, and help from loved ones. Your state’s Medicaid program may also be able to cover some of your costs if you qualify.
Are you enrolled in Medicare Advantage? Certain nursing homes have contracts with health insurance companies that provide Medicare Advantage plans (Medicare Part C). This means your Part C plan may help pay for nursing home care.
Medicare Part A covers skilled nursing care, in certain situations, for a limited time. To qualify, all of these conditions must be met:
- You have Part A and have days left in your benefit period to use.
- You have a qualifying hospital stay.
- Your doctor has decided that you need daily skilled care. It must be given by skilled nursing or therapy staff.
- It must be started within 30 days of your hospital stay.
- You get these skilled services in a skilled nursing facility that’s certified by Medicare.
- Days 1–20: $0 for each benefit period.
- Days 21–100: $185.50 coinsurance per day of each benefit period.
- Days 101 and beyond: All costs.