Unfortunately, Medicare nursing home coverage is extremely limited. Medicare doesn’t offer coverage for most long-term care services, including long-term stays at nursing homes, hospitals, or assisted living services. In some cases, you may have coverage for short-term stays at a skilled nursing facility.
When Does Medicare Cover Nursing Home Costs at a Skilled Nursing Facility?
While Medicare won’t cover long-term care at a nursing home, it does cover short-term stays at a skilled nursing facility (SNF). You may have coverage at an SNF if you meet the following criteria:
- You’re entering the SNF within 30 days after being admitted as in inpatient at the hospital for at least 3 days
- You’re entering the SNF for the same reason that you were hospitalized
- You need a skilled level of care that can’t be provided at home or in an outpatient setting
Services covered in a skilled nursing facility include:
- Intravenous injections
- Physical therapy
- Medication management
How Many Days Will Medicare Pay for Nursing Home Care at a Skilled Nursing Facility?
Medicare Part A partially covers costs at an SNF for the first 100 days of each benefit period. A benefit period begins on the day that you’re admitted as an inpatient to the SNF or hospital. It ends when you haven’t received any inpatient care at an SNF or hospital for 60 consecutive days. The Medicare Part A deductible restarts at the beginning of each benefit period.
The Medicare nursing home benefit varies depending on the amount of time that you’ve been admitted.
- Days 1-20 you pay nothing
- Days 21-100 you have a daily coinsurance amount of $176 (in 2020) for each benefit period
- Days 101 onwards, you’re responsible for all costs
Keep in mind that you need to ensure that the SNF accepts Medicare in order for Medicare to cover any costs. You can find an SNF that’s certified by Medicare using their online tool. In addition, not all services may be covered at an SNF. For instance, Medicare won’t cover a private nurse unless it’s deemed medically necessary. You can discuss your treatment with your healthcare provider to help ensure that the services they recommend are covered.
Do Medicare Supplements Help Cover Costs at a Skilled Nursing Facility?
Yes, Medicare Supplement plans will help cover the costs of skilled nursing facilities. They’re a form of secondary insurance, so they pay according to their plan details as long as Medicare pays first.
However, this means that since Medicare doesn’t offer coverage past your 100th day in a benefit period, neither will your Medicare Supplement plan. For instance, if you have Medicare Supplement Plan F, which covers the rest of the costs in Medicare-approved services, you could pay nothing out of pocket for the first 100 days in the benefit period. On the 101st day, you’ll be responsible for all of the costs.
Does the Medicare PACE Program Cover Nursing Homes?
PACE provides in-home care services that are similar to what’s offered in a nursing home. PACE may not be available in your area, and you have to meet specific income requirements to qualify. Your costs for PACE services will vary based on your income, so you should consult with PACE directly to determine what you may be responsible for.
Ultimately, if you or a loved one may need long-term care at a nursing home or assisted living services in the future, you shouldn’t rely on Medicare coverage to pay for them. You may want to review your options for a long-term care insurance policy, as they’re designed to cover these costs.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.