Medicare nursing home coverage is a complicated topic. What does Medicare cover? What does the patient have to pay on their own? The answers to these questions lie in the type of care you need. Medicare Part A will typically cover up to 100 days of skilled nursing care. Unfortunately, Medicare does not cover any type of long-term nursing care.
What Is a Nursing Home?
Nursing homes are facilities that provide specialized care for seniors who need assistance living. These types of facilities can give medical help or custodial help. Often times, loved ones are placed in, or opt to go to a nursing care facility due to the heavy demands of every day care the recipient needs.
Most nursing homes have skilled, trained nurses who specialize in treating all of the patient’s needs. Sometimes, there is also a doctor on staff who can treat conditions as well. There are many different types of nursing homes; some are more residential, with a home-like feeling, where others might feel more medical, with nurses’ stations and other hospital-like functions.
Does Medicare Cover Nursing Homes?
Medicare Part A works to cover inpatient care such as the type of care one would receive in a nursing home. This coverage, however, is limited. Medicare starts by covering 100% of the first 20 days of an eligible nursing home stay. After day 20, Medicare will only pay 80% of these costs. This means you will typically have to pay a $167.50 coinsurance per day, which is the remaining 20% of costs. This is the cost in 2018.
Once you reach 100 days in the nursing facility, Medicare will completely stop paying. This leaves you responsible for any costs associated with your nursing home stay. For this reason, Medicare claims to only cover short-term care. This type of short-term care might be necessary when recovering from an injury or an illness. If you need long-term care for an illness, disease, or disability, Medicare will not cover this.
Additionally, there are some services offered at nursing homes that Medicare might not cover. This includes a private room or custodial care.
Do Medicare Supplements Cover Nursing Homes?
If you are looking for ways to pay the costs of your nursing home coverage in full, a Medicare Supplement plan might be the answer. Some Medicare Supplement plans will cover the 20% ($167.50 in 2018) coinsurance that you would typically be responsible for from days 21-100. This ensures you are completely covered in the event you need to stay at a nursing home for a short duration of time.
Unfortunately, like Medicare, these plans do not cover long-term care. They are meant to fill the gaps in the Medicare coverage, and do so by paying the percentage of costs that Medicare does not cover.
Finding a Medicare Nursing Home
Once you determine that you might need nursing home care, it is essential to find one that accepts Medicare and is Medicare-certified. It is hard to do this alone. This is why Medicare created and provides a simple-to-use tool to allow seniors to find a nursing home.
To use this tool, fill out your zip code or location and the finder will tell you which Medicare nursing homes are in your area. After you find the available nursing homes in your area, you can compare the different facilities to find out which one best fits your needs. You can access this tool here.
Alternatives to Nursing Homes
While we discussed the amount of coverage Medicare provides for nursing home care, we understand that nursing homes are not always the preferred option. If this resonates with you, you might want to consider the Medicare PACE program. It provides at-home nursing home care with the same benefits of being in a skilled nursing facility.
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.