Medicare coverage for nursing homes and hospital stays

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.

Medicare nursing home coverage

Part A does not pay for nursing home custodial care like bathing, dressing, eating and using the bathroom. But if you need skilled nursing facility (SNF) care that’s medically necessary (for example, changing sterile dressings), Part A may help cover it.2

Note: If you have a Medicare Advantage plan (Part C), contact your provider. You may have extra benefits for vision, hearing and dental that Original Medicare doesn’t cover.3

How to qualify 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 can cover SNF care in certain conditions for a limited time if all of these conditions are met:4

  • You have Part A and have days left to use in your 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)

Medicare hospital coverage

Your hospital observation status affects how much Medicare will pay for hospital services. Part A can cover inpatient services if all of these are true:5

  • You’ve been formally admitted as an inpatient to a hospital with a doctor’s order to treat your illness or injury
  • The hospital accepts Medicare
  • The Utilization Review Committee of the hospital approves your stay (in some cases)

Generally, this means you pay a one-time deductible ($1,408 in 2021) for all of your hospital services for the first 60 days. Some of these services include meals, general nursing, semi-private rooms, drugs and supplies.6

Medicare Part A also covers the cost of a stay in a long-term care hospital (LTCH). LTCHs specialize in treating patients hospitalized for more than 25 days. Once admitted, you pay the same one-time deductible ($1,408 in 2021) for the first 60 days in each benefit period.7

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.

Sources

  1. “What Part A covers,” Medicare.gov, last accessed February 23, 2021, https://www.medicare.gov/what-medicare-covers/what-part-a-covers, opens new window.
  2. “Nursing Home Care,” Medicare.gov, last accessed February 23, 2021, https://www.medicare.gov/coverage/nursing-home-care, opens new window.
  3. “Nursing Home Care.”
  4. “Skilled nursing facility (SNF) care,” Medicare.gov, last accessed February 23, 2021, https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care#, opens new window.
  5. “Inpatient Hospital Care,” Medicare.gov, last accessed February 23, 2021, https://www.medicare.gov/coverage/inpatient-hospital-care, opens new window.
  6. “Inpatient Hospital Care.”
  7. “Long-term care hospital services,” Medicare.gov, last accessed February 23, 2021, https://www.medicare.gov/coverage/long-term-care-hospital-services, opens new window.

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