Medicare typically covers short-term stays in skilled nursing facilities but not long-term custodial care.

Medicare covers services like hospital stays, outpatient services, and preventive care. It may cover short-term stays in a nursing home when a person needs skilled care, such as for rehabilitation after discharge from a hospital.

However, if a person wants to move into a nursing home long-term, Medicare plans usually will not cover this cost.

Medicare covers care relating to the diagnosis and treatment of a disease, illness, or other health condition. This does not include long-term nursing home care.

To understand what Medicare covers in a nursing home, it’s sometimes best to know what the program doesn’t cover. Medicare doesn’t cover care in a nursing home when a person only needs custodial care. Custodial care includes the following services:

  • bathing
  • dressing
  • eating
  • going to the bathroom

As a general rule, if a person needs care that doesn’t require a degree to provide, Medicare doesn’t cover the service. This includes long-term care for people with dementia, which is considered custodial care.

But, if you need short-term care in a nursing home following a hospital stay, Medicare may cover it if you meet the requirements.

Requirements for Medicare to cover care in a nursing home

Medicare does cover skilled nursing care in a skilled nursing facility, but you have to meet several requirements. These include:

  • You must have Medicare Part A and have days left in your benefit period.
  • You must have first had a qualifying hospital stay.
  • Your doctor must determine you require daily, skilled nursing care.
  • You must receive this care at a skilled nursing facility.
  • The facility where you receive your services must be Medicare-certified.
  • You need skilled services for a hospital-related medical condition or a condition that started while you were in a skilled nursing facility getting help for the original, hospital-related medical condition.

It’s also important to note this care is for a short-term basis, not for long-term care.

Medicare typically pays 100% of the covered costs of skilled nursing facility care for up to 20 days.

After 20 days and up to 100 days, you will usually need to pay a co-pay of $204 per day.

A skilled nursing facility must admit the person within 30 days of their leaving the hospital and must admit them for the illness or injury for which the person was receiving hospital care.

After 100 days, Medicare will no longer cover skilled nursing care during that benefit period.

Note that if you have a Medicare Advantage plan, you may have to pay a copay during the first 20 days.

What happens when Medicare stops paying for nursing home care?

Medicare typically stops covering care in a skilled nursing facility after 100 days. At this point, you may have to pay out-of-pocket for care or use separate long-term care insurance.

Medicare usually only covers short-term skilled nursing care in a nursing home. Keep reading for a breakdown of what Medicare may cover related to nursing homes.

Medicare Part A

Some services Medicare Part A may cover in a nursing home environment include:

  • dietary counseling and nutrition services
  • medical supplies and equipment
  • medications
  • meals
  • occupational therapy
  • physical therapy
  • semi-private room
  • skilled nursing care, such as wound dressing changes
  • social work services related to needed medical care
  • speech-language pathology

Medicare may also cover “swing bed services,” which are when a person receives skilled nursing facility care in an acute-care hospital.

Medicare Part B

Medicare Part B pays for outpatient services such as doctor visits and health screenings. It doesn’t usually cover nursing home stays.

Do Advantage plans cover any part of it?

Medicare Advantage plans (also called Medicare Part C) don’t usually cover nursing home care that’s considered custodial care. A few exceptions exist, including if a person’s plan has a contract with a specific nursing home or organization that operates nursing homes.

Always contact your plan provider before going to a particular nursing home so you understand what services are and aren’t covered under your Medicare Advantage plan.

What about Medigap supplements?

Medigap supplement plans are sold by private insurance companies and help to cover additional costs, such as deductibles.

Some Medigap plans may help to pay for skilled nursing facility coinsurance. These include plans C, D, F, G, M, and N. Plan K pays for about 50% of the coinsurance, and Plan L pays for 75% of the coinsurance.

However, Medigap supplement plans don’t pay for long-term nursing home care.

What about Part D medications?

Medicare Part D is prescription drug coverage that helps pay for all or a portion of a person’s medications.

If a person lives in a nursing home, they’ll typically receive their prescriptions from a long-term care pharmacy that provides medications to those in long-term care facilities like a nursing home.

However, if you’re in a skilled facility receiving skilled nursing care, Medicare Part A will usually cover your prescriptions during this time.

Most Medicare plans won’t cover nursing home care. Exceptions may include if you purchase a Medicare Advantage plan with a specific agreement with a nursing home. Again, these are often the exception, not the rule, and available options vary geographically.

Options to help pay for nursing home care

If you or a loved one may need to transition to long-term nursing home care, options outside of Medicare may help offset some costs. These include:

  • Long-term care insurance: This may help to pay all or a portion of nursing home costs. Many people purchase these policies at a younger age, such as in their 50s, as the premiums usually increase in cost as a person ages.
  • Medicaid: Medicaid, the insurance program that helps cover costs for those in low-income households, has state and national programs that help pay for nursing home care.
  • Veterans Administration: The United States Department of Veterans Affairs may provide financial assistance for long-term care services to those who served as military personnel.

Some individuals may find they require Medicaid services after they exhaust their personal financial resources in paying for long-term care. To find out more on how to qualify, visit the State Health Insurance Assistance Programs network.

While a skilled nursing facility provides specific, trained care for medical conditions and rehabilitation on a short-term basis, a long-term nursing home provides custodial care.

A nursing home is a place where a person can receive extra care services from nurses or nurses’ aides.

Many of these facilities may be homes or apartments for people who need extra care for their daily activities or who no longer desire to live alone. Some resemble hospitals or hotels with rooms with beds and baths and common spaces for classes, recreation, eating, and relaxing.

Most nursing homes provide around-the-clock care. Services can vary but they may include help going to the bathroom, assistance getting medications, and meal services.

Advantages of nursing home care

  • Nursing home care often allows a person to live independently without having to engage in home maintenance activities, like mowing the lawn or upkeep on a home.
  • Many nursing homes also provide social activities that allow individuals to connect with others, maintain friendships, and participate in other activities.
  • Having nursing services and trained staff on hand to monitor a person can comfort the person and their family.

Financial organization Genworth tracked the cost of care in skilled nursing facilities and nursing homes in the U.S. from 2004 to 2021.

They found the average 2021 cost of a private room in a nursing home is $106,920 per year. Care in an assisted living facility costs about $54,000 per year on average.

Nursing home care is expensive. These costs include care for increasingly sicker patients, employee shortages, and greater regulations that increase expenses.

Tips for helping a loved one enroll in Medicare

If you have a loved one who is reaching age 65, here are some tips on how you can help them enroll:

  • You can start the process 3 months before your loved one turns 65. Starting early can help you get needed questions answered and take some stress out of the process.
  • Contact your local Social Security Administration or find a location by visiting their official website.
  • Visit Medicare.gov to find out about available health and drug plans.

Medicare Part A can cover skilled nursing care in a nursing home environment, providing a person meets specific requirements.

If you or a loved one desires or needs to live in a nursing home long-term to receive custodial care and other services, you’ll likely be required to pay out-of-pocket or utilize services like long-term care insurance or Medicaid.