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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 covers doctor office visits, outpatient surgical procedures, ambulance services, lab work, mental health services, and more.

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. Most nursing home care is custodial care.

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.

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 $194.50 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 cover the cost of nursing home stays.

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 copayments, 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. 

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.

Sources:

Medicare.gov. “Nursing home care.” Accessed August 2022.

Medicare.gov. “Skilled nursing facility (SNF) care.” Accessed August 2022.

Disclaimer:

Insure.com is not affiliated with or endorsed by the government or Federal Medicare program. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day/7 days a week, to get information on all of your options. Not all plans offer all of these benefits. Benefits and availability may vary by carrier and location. Limitations and exclusions may apply. Every year, Medicare evaluates plans based on a 5-star rating system. Part B Premium give-back is not available with all plans. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

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Les Masterson
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Les, a former managing editor, insurance, at QuinStreet, has more than 20 years of experience in journalism. In his career, he has covered everything from health insurance to presidential politics.

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