Medicare is a federally funded insurance program for adults over 65, in addition to younger people with certain disabilities. Medicare won’t cover long-term nursing home stays, but it can cover short-term skilled nursing care after an individual’s injury or illness. To determine if Medicare will cover nursing home costs for your loved one, first consider their care needs. Below we’ll explore Medicare plan types and the difference between short-term and long-term nursing home stays.
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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.
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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For Medicare to pay for a short-term nursing home stay, a senior must:
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 $7,800 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.
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]
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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]
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:
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 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 work through your budget — all at no cost to your family.
United Healthcare. (2023). What’s the difference between a skilled nursing facility and a nursing home?
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., & 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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