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Does Medicare Cover Nursing Homes?

Christian Worstell by Christian Worstell    |    Published Nov 06, 2019    |    Reviewed by John Krahnert

Medicare Part A covers limited skilled nursing care, as long as it is medically necessary to treat an injury or illness and you meet certain conditions. Medicare does not cover long-term care or custodial care, if that is the only care you require.

If you receive care in a skilled nursing facility, you will typically face certain out-of-pocket Medicare costs.

A Medicare Supplement (Medigap) plan can help pay for your skilled nursing facility care costs, such as Medicare deductibles and coinsurance.

Nurse embraces patient in a wheelchair outside of nursing facility
Medigap plans can help cover care you receive in a skilled nursing facility.

Who Qualifies for Skilled Nursing Facility Care Coverage?

 Medicare may cover certain nursing home costs if: 

  • Your doctor decides you need care from skilled nursing facility staff

  • You receive care at a skilled nursing facility that’s certified by Medicare

  • The skilled services you receive address a medical condition that was treated during your qualifying three-day inpatient stay in a hospital

How Much Do Skilled Nursing Facilities Cost?

Medicare Part A will help pay for skilled nursing care for up to 100 days at a time. Called a “benefit period,” these benefits reset when you’ve stopped receiving skilled nursing care for 60 consecutive days.

Your Part A benefits work like this:

  • Medicare Part A pays all of your costs for the first 20 days. You pay nothing.

  • For days 21-100, you are responsible for a daily $170.50 coinsurance in 2019.

  • If you require skilled nursing care longer than 100 consecutive days, you are responsible for all costs.

There are other additional conditions to keep in mind. Be sure to ask your doctor or health care provider about whether the services they provide will be covered by Medicare.

Custodial Care vs. Skilled Nursing Facility Care

Custodial care is non-medical assistance with daily activities such as bathing, dressing, eating and using the restroom. Custodial care can occur at a person’s home or in a nursing or assisted living facility. 

Although Medicare does not cover custodial care, it does cover some skilled nursing services (for a limited time under certain circumstances), including:

  • Semi-private rooms

  • Food

  • Skilled nursing care

  • Physical therapy and occupational therapy

  • Speech-language pathology care

  • Prescription drugs

  • Social services

  • Medical equipment and supplies

  • Counseling on your diet

  • Transportation via ambulance

Medicare Part A also covers intermittent skilled nursing care at home, but it is restrictive.

Certain Medigap Plans Help Pay for Skilled Nursing Care

If you’re concerned about your ability to pay for a lengthy round of skilled nursing care, certain Medigap plans can help.

Eight of the 10 standardized Medigap plans available in most states offer at least partial coverage for your skilled nursing facility coinsurance. Six Medigap plans cover these costs completely.

Keep in mind that Medigap plans won’t pay for long-term nursing home care or custodial care, either.

Other Original Medicare out-of-pocket costs include:

  • Part A deductible ($1,364 per benefit period in 2019)

  • Part B deductible ($185 per year in 2019)

  • Part A coinsurance ($341 per day for days 61-90 spent in a hospital per benefit period in 2019). Your coinsurance will increase if you go beyond day 90.

  • Part B coinsurance (20% of the Medicare-approved amount for most doctor services)

A licensed agent can help you decide on a Medigap plan option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

 

Find Medigap plans that help cover skilled nursing facility care.

Compare Plans

Or call --ms-tfn-- to speak with a licensed insurance agent.


 

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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