Medicare doesn’t usually cover nursing home and long-term care. However, there are exceptions.
Nursing home care is costly. The average cost for semi-private and private nursing home rooms is more than $200 a day. Also, assisted living facilities cost an average of more than $100 a day.
The bad news is that Original Medicare, which makes up Parts A and B, doesn’t pay for nursing home care. Instead, Part A covers hospital care and Part B handles physician services.
How long can you stay in a nursing home with Medicare?
Medicare only covers “medically necessary skilled care.” It doesn’t cover custodial care, which involves daily living activities like dressing and bathing or room and board at a nursing home.
Medicare Part A covers skilled nursing facilities (SNFs) for up to 100 days if you meet requirements. That criteria include entering an SNF within 30 days of a hospital stay and the short-term care facility’s care must be beyond what could be received in a home or outpatient setting.
Paying for SNF care beyond 100 days is the patient’s responsibility. Medicare may cover skilled therapy if it’s considered medically necessary but won’t pay for the SNF’s room and board.
Although Medicare doesn’t cover regular nursing home care, you shouldn’t drop that coverage. Medicare still covers hospital and physician care, which people still need when they’re in a nursing home. However, if nursing home care is a vital benefit for you, check out Medicare Advantage plans to see if there are any in your area with that coverage.
How much does Medicare pay for nursing home care?
Original Medicare doesn’t often cover nursing home care unless it’s medically necessary.
However, it covers 100 days of SNF care as long as you meet requirements. You have to enter an SNF or nursing home providing medically necessary care within 30 days of hospital discharge. That hospitalization must last at least three years.
Medicare only pays for medical treatment. It doesn’t reimburse for custodial care.
Medicare fully covers the cost of room and board, meals, skilled nursing, rehab services and medical supplies for the first 20 days in an SNF. After that, the patient must pay $176 per day until day 100. After the 100th day, the patient must pay all costs.
How does Medicare Advantage help with nursing home care?
Original Medicare doesn’t cover most nursing home stays, but a Medicare Advantage plan may.
Medicare Advantage, also called Part C, is offered by private insurers. More than one-third of Medicare beneficiaries have a Medicare Advantage plan rather than Original Medicare.
The federal government allows more leeway for Medicare Advantage to offer supplemental benefits, such as home and custodial care.
The Medicare Advantage insurer needs a contract with a facility to cover nursing home stays. Check with the plan’s network before signing up.
If a loved one is headed to a nursing home, check with his or her Medicare Advantage insurer to see which nursing homes are covered in the plan. Once you have a list of local nursing homes in the plan, you can research each one to find a facility that’s high quality and fits your loved one’s needs.
How does Medicaid help with nursing home care?
Medicaid is one way that people get help paying for nursing home care.
Medicaid is a federal/state program for low-income people. Most nursing homes accept Medicaid.
You might think you’re well off and wouldn’t qualify for Medicaid. However, people in nursing care often deplete their savings by paying for nursing home care and become eligible for Medicaid.
States determine Medicaid eligibility based on income and resources. Many states have higher income limits for nursing home residents, which make it easier to get coverage.
Check with your state about eligibility.
How does Medigap help with nursing home care?
Beneficiaries with Original Medicare are eligible for Medigap. Medigap is a supplemental policy that assists with copayment, deductibles and out-of-pocket costs.
Private companies offer 10 types of Medigap plans with varying levels of coverage.
Medigap plans can cost less than $100 a month or more than $300 depending on the coverage and deductibles. Some plans help with SNF coinsurance costs; others don’t pay for that care or only reimburse a portion of the costs. Read the Medigap plan specifics to see what it covers.
How does long-term care insurance help with nursing home care?
One way to get help with future nursing home care is through long-term care (LTC) insurance.
LTC coverage varies by plan. An LTC insurance policy may or may not cover nursing home, adult day, home and assisted living. Read the fine print to see what an LTC insurance policy covers before signing up.
Also, check about pre-existing condition limitations when shopping for LTC coverage and make sure you research the company’s reputation — both consumer and financial — so you choose a company that will last and is respected by consumers and officials.
You can also get LTC coverage through a combination life insurance policy. Combination life insurance is a permanent life policy that includes an LTC rider. It’s more expensive than LTC insurance but offers the benefit of a life insurance policy. Money not used while you’re alive goes to a death benefit for your loved ones.
Does Medicare pay for nursing home care for Alzheimer’s disease?
Original Medicare doesn’t cover long-term nursing home care, no matter the illness.
It will pay for up to 100 days in an SNF under the requirements mentioned above. It will also cover inpatient hospital care and hospice care in a nursing facility or at home. However, Original Medicare won’t cover custodial care in a nursing home regardless of the reason for the admission.