Medicare will cover nursing home costs for your loved one if they meet Medicare’s qualifications, like being an inpatient at a hospital and having a doctor’s order for post-hospital nursing care. Medicare (Part A) can also cover short-term nursing care for rehabilitative needs. Medicare won’t cover long-term nursing home stays if custodial care is all that’s needed. Below, we’ll detail the qualifications for Medicare coverage and explore different plan types that cover skilled nursing home stays.
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Medicare Part A, also called Hospital Insurance, can cover certain short-term stays in nursing homes or skilled nursing facilities to recover from illness, injury, or surgery. A senior must meet several criteria for Medicare Part A as well as Medicare’s nursing home criteria. To be covered under Part A Hospital Insurance, stays must be considered rehabilitative after a hospital visit and prescribed by a doctor.
For Medicare to pay for a short-term nursing home stay, a senior must meet the following requirements:
Medicare Part A will fully cover a senior’s rehabilitative stay in a nursing home for up to 20 days, and partially from days 21-100. Medicare stops covering custodial costs after 100 days but will cover skilled or medical care services thereafter. This period is intended to help an individual recuperate after a hospital stay.
Medicare Part A covers 100% of the costs for the first 20 days in a nursing home. On day 20, your loved one may have to pay up to $204 a day in coinsurance costs.[04] Coverage of nursing home care stops after day 100.[03] If your loved one needs to be in the nursing home longer, your family may have to rely on other resources to pay for care, like long-term care insurance.
Consider that a semi-private room in a nursing home has a median monthly cost of $7,800 in the U.S.[05] So, even if your loved one has to pay the maximum of $204 in coinsurance for 80 days, they’ll be paying $16,320 for a full 100-day stay, instead of over $24,000.
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Medicare Advantage — also called Medicare Part C — plans can be purchased through private companies 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.[07]
If your loved one has a Medicare Advantage plan, they also have Hospital Insurance, as described above, so they’ll receive rehabilitative treatment in a nursing home covered by Medicare. After their 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 activities of daily living (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.[07]
Care provided in nursing homes can be broken down into two categories: custodial care and skilled nursing care. Original Medicare pays for skilled care services, but not custodial care, during long-term nursing home care.[02]
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:
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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.
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 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 work through your budget — all at no cost to your family.
Centers for Medicare and Medicaid Services. Inpatient hospital care.
Centers for Medicare and Medicaid Services. Nursing home care.
Medicare Interactive. SNF care past 100 days.
Centers for Medicare and Medicaid Services. (2022, December). Medicare coverage of skilled nursing facility care.
Genworth. (2022, February 7). Cost of Care trends and insights.
Department of Health and Human Services. (2015, April). What’s a Medicare Advantage plan?
Sung, J.E., and Noel-Miller, C. (2018, October 30). Supplemental benefits in Medicare Advantage: What’s changing in 2019 and what’s not. AARP Public Policy Institute.
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