Medicare Part A (hospital insurance) helps cover some medical services in nursing homes and hospitals. However, there are limitations to long-term care and which services and treatments are covered.1
Here’s a closer look at Medicare coverage for nursing homes and hospital stays.
When does Medicare cover nursing home care?
Medicare will not usually cover services that help with everyday life functions, such as assistance with dressing, eating or going to the bathroom. Generally, if the care you receive in a nursing home does not require a degree to provide, Medicare won’t cover it.2 However, Medicare Part A may provide coverage for skilled nursing facility (SNF) care that’s medically necessary (for example, changing sterile dressings).
Note: If you have a Medicare Advantage plan (Part C), contact your insurance carrier. You may have extra benefits for vision, hearing and dental that Original Medicare doesn’t cover.4
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What is the difference between a skilled nursing facility and a nursing home?
At a skilled nursing facility, care is usually provided by registered nurses under the supervision of a doctor. Generally, patients will go to a skilled nursing facility for recovery after an injury, sickness or surgery. The care is usually meant to be temporary, with patients returning home once they are able.
At a nursing home, the care is typically more long-term. Licensed practical nurses or nurse aides help residents with daily life functions, such as bathing, dressing or eating. This care is meant for patients who may not be able to live comfortably on their own due to chronic conditions.
Which parts of Medicare cover nursing homes?
Medicare Part A
Medicare Part A does not cover most nursing home care. Medicare Part A may help cover some medical services in a nursing home under certain conditions. If you need skilled nursing care, such as changing sterile dressings, Medicare Part A may help cover some costs.
Medicare Part B
Medicare Part B helps cover most preventive care and medically necessary doctor’s services. In a long-term care setting, this could mean services such as physical therapy or speech therapy. After 100 days in a long-term care facility each benefit period, this type of care is no longer covered by Medicare Part A. At this point, Medicare Part B is typically used to help cover some of the costs of these services.
Medicare Advantage plans, also called Medicare Part C, are Medicare-approved and offered by private companies. These plans include everything covered under Medicare Parts A and B. Typically, Medicare Advantage plans will not help pay for custodial care in a nursing home. However, there may be some exceptions, depending on the specifics of your Medicare Advantage plan. Be sure to contact your insurance provider to know what your plan covers (and what it doesn’t) before entering a long-term care setting.
Medigap Supplement Plans
Medigap plans, or Medicare Supplement insurance plans, are offered by private companies. This insurance is meant to help cover some costs associated with Original Medicare, such as copays and deductibles.
Unfortunately, Medigap generally won’t cover nursing home care. However, it may help with some of the costs for short-term care, such as copays or coverage toward deductibles.
Part D Plans
Medicare Part D is prescription drug coverage designed to help pay for medication. If your stay in a long-term care facility is covered by Medicare Part A, then some of your prescription drugs may also be covered under Part A. If your stay is not covered by Medicare, then you may be covered for certain medications under a Medicare Part D prescription drug plan if you’re already enrolled in Part D.
Medicare coverage requirements for skilled nursing facility (SNF) care
SNF care is nursing and therapy that can only be performed or supervised by professionals or technical personnel. Medicare Part A may help cover SNF care in certain conditions for a limited time if all of these conditions are met:2
- You have Part A and have days left to use in your Medicare benefit period
- You have a qualifying hospital stay
- Your doctor decided that you need daily skilled care
- The SNF where you get skilled services is certified by Medicare
- You need these skilled services for a medical condition that’s either:
- A hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay, even if it wasn't the reason you were admitted to the hospital
- A condition that started while receiving care in the SNF for a hospital-related medical condition (for example, you develop an infection that requires IV antibiotics while getting SNF care)
How long will Medicare cover a nursing home stay?
Medicare Part A may pay for medical services at a long-term care facility for up to 100 days. After this period, Medicare may still be used to cover some treatments, such as occupational therapy, speech therapy or speech-language pathology. However, Medicare won’t cover room and board after 100 days.3
How can I pay for long-term nursing home care?
If you need coverage beyond 100 days of skilled nursing care, or if you need help with the cost of nursing home care, you may have other options:4
- Medicaid: Depending on your income, you might qualify for Medicaid. This could help you cover some of the costs of long-term care. Medicaid coverage and eligibility requirements vary from state to state.
- Social Security Administration programs: Some programs offered through Social Security could help cover some costs associated with long-term care for people with disabilities. Depending on your medical condition or income, you might qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
- Long-term care insurance: 1 possible source of coverage for nursing home services is long-term care insurance. These are plans offered through private insurance providers. Details of coverage and costs may vary from plan to plan.
Talk to someone you trust about long-term care
If you need long-term care, or you’re planning ahead, you may have options available. Talk to family, your doctor or a counselor for help choosing the best option for you.