Does Medicare Cover Nursing Homes? It Depends on the Length of Stay

Medicare nursing home coverage varies by the length of your loved one’s stay.

Some seniors will only reside in a nursing home or skilled nursing facility (SNF) for a short period of time to recover from an injury, illness, or surgery. These rehabilitative stays are prescribed by a doctor and generally last for a period less than 100 days. Medicare Part A covers most nursing home costs during this time for qualifying seniors.

However, your loved one may have a chronic health condition that requires long-term 24-hour care supervised by a doctor or nurse. In this case, they may choose to move into a nursing home as their permanent residence. If a senior lives in a nursing home for an extended period of time, Medicare will cover some costs but not others.

Note that, while “skilled nursing facility” and “nursing home” sound similar and are often used interchangeably, an SNF is generally designed for short-term rehabilitative stays but not long-term residential living.^[01] In contrast, a nursing home offers 24-hour medical care in a safe environment with private or semi-private rooms, as well as activities and therapies designed to help residents and patients maintain independence and improve quality of life.

Below, we’ll explore the ins and outs of what Medicare nursing home coverage involves for each duration of stay.

While Medicare doesn’t pay for long-term stays in nursing homes, Medicare Part A, also called Hospital Insurance, can cover certain short-term stays. A senior must meet several criteria for Medicare Part A to cover their short-term nursing stay, as described below.

How long does Medicare pay for short-term nursing home care?

Medicare Part A will cover a senior’s rehabilitative stay in a nursing home for up to 100 days when that care is prescribed by their doctor. This period is intended to help an aging adult recuperate from an illness or injury that led to a hospital stay. During those 100 days, your loved one can benefit from physical therapy, nursing care, medication management, and assistance with ADLs like dressing, bathing, and using the toilet.

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How does a senior qualify for Medicare nursing home coverage?

For Medicare to pay for a short-term nursing home stay, a senior must:

• Have Medicare Part A. When a person signs up for Medicare, Hospital Insurance is automatically included, unless they request otherwise.
• Choose a Medicare-certified nursing home or skilled nursing facility. Not all nursing homes are certified by Medicare. Some private facilities, for example, may choose to only accept patients who can pay out of pocket.
• Have been discharged from a three-day or longer inpatient stay, during which they were admitted to a hospital. Not all hospital stays qualify — when your loved one is checked in at the hospital, ask if they’re being admitted or if they’re only there for observation. Even if they stay overnight, a period of observation doesn’t qualify a senior for a nursing home stay covered by Medicare after their release. Sometimes, an older adult will be held for observation before being officially admitted. So, if your loved one isn’t admitted until day two of their stay, they’ll have to be in the hospital for four days before their Medicare benefit period kicks in.^[02]
• Have a doctor’s prescription for skilled nursing care, per Medicare’s guidelines. For Medicare to pay, your loved one’s physician or emergency room doctor must prescribe a rehabilitative stay in a nursing home or skilled nursing facility.
• Require care related to a specific medical condition. This can be either the condition treated during the qualifying hospital stay or a separate health concern that began during their nursing home stay.
• Be admitted to the nursing home or skilled nursing facility within 30 days of leaving the hospital. Generally, your loved one’s doctor will recommend a facility for them to move into after the hospital stay. Keep in mind that there may be waiting lists.
• Need daily skilled care. If your loved one only needs assistance with ADLs like dressing and bathing but doesn’t require medical care from a skilled nursing or therapy staff, they won’t qualify for a nursing home stay funded by Medicare.^[03]
• Accept a semi-private room. Medicare doesn’t cover private rooms in nursing homes, except when medically necessary.

How much does Medicare pay for a nursing home?

Medicare Part A’s coverage of nursing home payments stops after day 100. If your loved one needs to be in the nursing home longer, whether they require further rehabilitation or choose to move in as a long-term resident, your family will have to rely on other resources to pay for care.^[04]

Even during the original 100-day period, a patient may have to pay some amounts out of pocket. The first 20 days will be free, but starting at day 20, your loved one may have to pay up to $200 a day in coinsurance costs.^[05]

While $200 a day sounds like a lot, Medicare still covers the majority of nursing home costs during the initial benefit period. Consider that a semi-private room in a nursing home has a median monthly cost of $7,908 across the U.S.^[06] So, even if your loved one has to pay the maximum of $200 in coinsurance each day for 80 days, they’ll be paying $16,000 — approximately the cost of two months of care — for that full 100-day stay.

Read more:What Happens When Medicare Stops Paying for Nursing Home Costs

Medicare Advantage — also called Medicare Part C — plans can be purchased through private companies that vary based on where your loved one lives. These plans generally accompany Medicare Parts A and B but provide additional services, such as nonemergency hearing, vision, and dental care.^[08]

If your loved one has a Medicare Advantage plan, they also have Hospital Insurance, as described above, so they’ll still be able to receive 100 days of rehabilitative treatment in a nursing home covered by Medicare. After that benefit period ends, Advantage plans will cover some of the costs of medical care in a nursing home or skilled nursing facility, but they won’t cover custodial care, help with ADLs, or monthly rent.

Keep in mind that Medicare Advantage plans may have different rules regarding coinsurance. Some families may find that even the first 20 days of nursing home care aren’t fully covered, and they could have coinsurance expenses beyond $200 a day throughout their stay.

Because of a change made in 2019, some Medicare Advantage plans may cover individual personal care services. These select few plans cover services with a “functional impact on health issues” and are designed to reduce the need for emergency services down the road.^[08]

Talk with a Senior Living Advisor

Care provided in nursing homes can be broken down into two categories: custodial care and skilled care. Original Medicare pays for skilled care services, but not custodial care, during long-term nursing home care.^[03]

• Custodial care includes assistance with activities of daily living (ADLs) including dressing, bathing, and using the toilet. Because this type of personal care is nonmedical, it can be provided by care aides and doesn’t require a nurse or doctor. Medicare may cover some memory care services if those services are medically necessary.
• Skilled care, or skilled nursing care, requires the provider to have a degree or certification. Skilled care generally includes wound care, injections, medication administration, and physical therapy.

What does Medicare cover in long-term nursing home care?

Your loved one’s Medicare benefits can cover some long-term care services offered in nursing homes. Medicare-covered long-term care services include the skilled care services mentioned above, along with:

• Medical devices like wheelchairs, oxygen, and walkers
• Medical supplies, such as bandages, sharps, or incontinence supplies
• Physical, occupational, or speech therapy
• Part-time or intermittent skilled nursing for an acute condition
• Medical social services to cope with side effects of a chronic illness

If your loved one needs a short-term rehabilitative stay in a skilled nursing facility or nursing home, their doctor will likely provide information and recommendations when they prescribe the stay.

You can also use A Place for Mom’s Guide to Choosing a Nursing Home.

However, if your relative needs help aging safely and would benefit from senior living, there are multiple potential options to pursue. While nursing homes offer the highest level of medical care, assisted living and memory care communities can also offer safe, supportive residential environments for aging adults to call home.

Reach out to one of A Place for Mom’s Senior Living Advisors to discuss senior living options near you, set up tours, and explain long-term care costs — all at no cost to your family.