Does Medicare Nursing Home Care?
- Reviewed by John Krahnert, Compliance Director
While Medicare covers skilled nursing facility care, it doesn't typically cover nursing home care. Learn more about the difference and find out when and how Medicare covers nursing care.
Medicare covers inpatient care at a skilled nursing facility (SNF) if it is deemed medically necessary. In these cases, the coverage includes various services and treatments to help beneficiaries recover from an illness or injury. Original Medicare, however, does not cover longterm care at a nursing home.
You may be able to find a Medicare Advantage (Part C) plan that covers benefits Original Medicare (Part A and Part B) doesn't cover, depending on the plans available where you live. Like Original Medicare, however, Medicare Advantage plans do not typically cover nursing home care.
What Is Medicare Nursing Home Coverage?
According to the Centers for Medicare & Medicaid Services (CMS), Original Medicare (Part A and Part B) medical insurance does not pay for nursing home costs when only custodial care is necessary. Custodial care involves help with everyday tasks like bathing, clothing oneself and eating.
In cases where skilled nursing care is required in addition to custodial care, Medicare may provide some coverage under specific conditions, even in a nursing home facility.
Medicare coverage for these services can include physical therapy or administration of medications by a nurse. Again, custodial care isn't covered by Original Medicare, but skilled nursing care services are.
- Custodial Care: Assistance with daily living activities (not covered)
- Skilled Medical Services: Professional healthcare services provided alongside custodial care (may be covered by Medicare Part A and Medicare Advantage plans)
Medicare Advantage (Medicare Part C) plans are a type of medical insurance sold by private companies that provide coverage for Medicare Part A and Part B benefits, combined into a single plan. Plans may also cover other benefits that Original Medicare doesn't cover.
Before receiving inpatient or outpatient care services, find out whether your nursing care is covered by Medicare and how much your nursing care costs with Medicare.
What Does Medicare Cover in a Skilled Nursing Facility?
Original Medicare may provide coverage for various services within an SNF such as:
- Semi-private room
- Meals
- Nursing care
- Certain medications
- Physical and occupational therapy
- Social work services
- Durable medical equipment (DME)
How Much Will Medicare Pay for Nursing Home Care?
Medicare Part A covers skilled nursing facility stays without any cost for the first 20 days. However, from day 21 to day 100 of your stay at the facility, you will be responsible for paying a coinsurance fee that can reach up to $200 per day in 2023.
To qualify for this coverage under Medicare Part A (Hospital Insurance), certain conditions must be met:
- You must have had a qualifying hospital stay lasting at least three consecutive days prior to entering the SNF.
- Your doctor must certify that you require daily skilled care for a condition related to your hospital stay.
- The SNF must be Medicare-certified, ensuring it meets specific quality and safety standards set by the government.
Conclusion
Understanding Medicare nursing home coverage is essential for beneficiaries who may require long-term care.
Medicare covers stays in skilled nursing facilities, but only for a limited time and under certain conditions. After day 100, patients are responsible for all costs incurred in the nursing home stay.
Learn more about privately sold Medicare Advantage plans that cover all of your Original Medicare benefits in a single plan and may include extra benefits that Original Medicare doesn't cover. Request a free plan quote or call to speak with a licensed insurance agent who can help you compare local plan options.