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When does Medicare cover nursing home care?
With Medicare, nonmedical long-term care in a nursing home is usually not covered. This is generally true for all kinds of “custodial care”. Custodial care includes things like food preparation and other chores around the house. Someone who is not a medical professional can provide it.
There are some cases where short-term care is covered. Medicare may cover skilled nursing care during a limited stay if you meet certain requirements. This is usually only if the care is medically necessary. Some Medicare Advantage plans offer benefits that help pay for some services during a long-term stay.
Which parts of Medicare have nursing home coverage?
You typically can’t get covered long-term care with Medicare. So, does Medicare pay for any nursing home care? Outside of the medical care you need, it doesn’t. But different parts of Medicare may help with services like skilled nursing care.
Medicare Part A offers hospital insurance. This usually has nothing to do with nursing home care. It might cover certain skilled nursing care in a nursing home setting if it’s medically necessary.
Medicare Part B offers medical insurance. This usually means preventive care, which you could receive in a nursing home setting. But Part B doesn’t cover the stay itself unless it’s a medically necessary short-term stay. A long-term stay with custodial care would not be covered.
Medicare Advantage (Part C) offers all the coverage you get from Parts A and B. Other benefits are often included depending on your plan. Like Part A and Part B, Medicare Advantage does not usually cover custodial care. You can get an Institutional Special Needs Plan (I-SNP) that may offer this coverage.
Medicare Part D offers prescription drug coverage. If you need a covered prescription drug while staying in a nursing home, Part D will help pay for it. But that’s also true if you needed a prescription drug while living anywhere.
Medicare Supplement (Medigap) insurance plans offer extra coverage for out-of-pocket costs linked to Parts A and B. This may include assistance with short-term stays that your doctor says you need. Otherwise, Medicare Supplement plans don’t offer nursing home coverage.
Skilled nursing facility vs. nursing home
Nursing homes mostly provide long-term custodial care. This care is often provided by nonmedical professionals. It includes things like chores and other tasks older people may struggle with. Nursing homes are made to create a safer, more convenient daily life. Medical care from skilled professionals may also be included if you need it.
Skilled nursing facilities offer short-term professional medical care. This care is usually for people who are recovering from surgery or some other health condition. Once a person has recovered from their condition, they usually leave the facility.
Medicare and long-term care don’t often go together. Long-term nursing home stays are generally not covered. Some medically necessary care may be covered while you are staying in a nursing home, but the stay itself and non-medical services typically aren’t. You are more likely to get Medicare coverage in a skilled nursing facility because the care it offers is short-term and needed for medical reasons.
How much does a nursing home cost?
Nursing home costs vary depending on the privacy of your room. For a private room, the average cost is about $10,965 per month. For a semi-private room, the average cost is $9,555 per month.
How long does Medicare pay for nursing home care?
Medicare Part A may pay for a stay for up to 100 days if it’s medically necessary. Past 100 days, only specific treatments may be covered. Here are some other coverage options you have:
Medicaid – If you meet the income requirements, Medicaid may pay for some nursing home costs.
Social Security Administration programs – If you have a qualifying medical condition, you may be able to get Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
Veterans Administration (VA) benefits – There are many VA nursing home-related services, both long and short-term.
Long-term care insurance – You can find specific plans for long-term care through an insurance company.
Financial planning – With a little planning, you may find your finances can handle a nursing home. Consider using the value of assets like investments, or even your home.