Does Medicare Cover Nursing Homes?
Does Medicare Cover Nursing Homes?
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Medicare does not cover long-term nursing home stays.
According to the Administration on Aging, 65-year-olds have a 70% chance of needing long-term care, with 20% needing care for more than five years. Medicare only covers short-term stays in skilled nursing facilities after certain hospital visits. Medicare Special Needs Plans, Medicare Supplement plans and long-term care insurance could help provide coverage for longer-term nursing home stays.
Does Medicare pay for nursing home care?
Medicare does not cover live-in nursing home care or the cost of living in a nursing home long term.
Medicare Part A, which covers inpatient hospital stays and skilled nursing, doesn't cover "custodial care," which means help for daily living activities such as bathing, eating and dressing. Long-term nursing home care usually falls into this category, so it isn't covered by Medicare.
Medicare Part A covers short-term stays in skilled nursing facilities. For example, if you need inpatient physical therapy after a surgery — meaning you have to stay admitted to the hospital or a care facility during your treatment — Medicare Part A could cover those costs.
How much does Medicare pay for nursing homes?
If you are admitted to a hospital and then to a short-term skilled nursing facility, the total amount Medicare pays will depend on the cost of your health care. You'll pay the $1,600 Medicare Part A deductible.
Then you'll have to pay the copay amount for your inpatient hospital stay. If you're in the hospital for 60 days or fewer, you won't have a copay. If you're admitted for over 60 days, your copay is at least $400 and could be more, depending on how long you're hospitalized.
Once you move to a skilled nursing facility, you'll pay a percentage of your daily costs, called coinsurance, and Medicare will pay the rest.
Days in skilled nursing facility | Cost you pay per day in 2023 |
|---|---|
| 0-20 | $0 |
| 21-100 | Up to $200 |
| 101 or more | All costs |
Remember that Medicare only pays for short-term nursing home stays and only when you've had a qualifying hospital stay. You will pay the full cost of skilled nursing home care starting on day 101.
When you are admitted on an inpatient basis to a hospital or skilled nursing facility, you start a "benefit period," which includes your stay in the hospital and your nursing care afterward. During each benefit period, you pay your Part A deductible before insurance kicks in and covers some of the costs.
The benefit period ends when you haven't had inpatient care for 60 days. If you're hospitalized after a benefit period ends, a new one will start. You'll pay the $1,600 Part A deductible and your copay and coinsurance amounts again for a new hospital and skilled nursing facility stay.
Average nursing home costs
A shared nursing home room costs $94,900 per year, according to Genworth Financial.
A private room is even more expensive, costing around $108,405 per year. The cost of a nursing home varies by state, too. Alaska has the highest cost, at $378,140 for both shared and private rooms. Texas has the cheapest cost for shared rooms, at $61,503 per year. Missouri's private room cost of $71,175 per year is the cheapest.
Nursing home costs are increasing. The rate for a semi-private room increased by just under 3% between 2017 and 2021, while private rooms increased in price by 3.25%.
How to pay for nursing homes
Medicare Supplement plans, long-term care insurance and Medicaid can help reduce the cost of nursing home care. Long-term or permanent living in nursing homes is expensive though, and you'll likely still have to pay most of the cost yourself.
- Medicaid: Medicaid can help offset the cost of a nursing home, but not everyone qualifies. Medicaid is typically reserved for those with low incomes, although there are other ways to qualify. However, not all nursing homes accept Medicaid.
- State assistance programs: Some states have programs to help residents get long-term care. For example, the Iowa Long-Term Care Partnership Program partners with Medicaid and private insurance companies. The program can allow you to qualify for Medicaid while protecting your assets.
- Long-term care insurance: These policies, also LTC policies, usually cover long-term care arrangements like nursing homes and home health care. LTC insurance doesn't usually cover the full cost of nursing homes, so you'll still have out-of-pocket costs.
- Medicare Supplement: These plans are also called Medigap plans, and they pay for some costs that Original Medicare doesn't. Plans C, D, F, G, M and N cover 100% of skilled nursing facility care, which means you wouldn't have to pay for your short-term stay. Plan K covers 50%, and Plan L covers 75%.
- Medicare Advantage: Also called Medicare Part C plans, Medicare Advantage policies bundle Original Medicare together and provide extra benefits. Part C doesn't usually cover nursing home care. Each company has its own plans and features, though, so you may find a policy with long-term care perks.
- Medicare Institutional Special Needs Plan: Also called an I-SNP, this is a type of Medicare Advantage plan that includes extra perks for people who need long-term care. To qualify, you have to be in (or expect to be in) a care facility for 90 or more days, or need the same level of care at your home. Qualifying locations include long-term care, skilled nursing and psychiatric facilities.
- Veterans Affairs: Veterans who already get a VA pension might qualify for the VA Aid and Attendance or Housebound allowance if they meet certain criteria, such as needing help with daily tasks.
The Program of All-Inclusive Care for the Elderly (PACE) is a Medicare program that helps people with extensive health care needs avoid long-term nursing home care. If you join PACE, you'll have a team of health care professionals to coordinate your care. The program even provides transportation to its PACE centers for appointments and other activities. Most PACE participants are eligible for both Medicare and Medicaid. But you can join even if you only have one program, or if you don't have either.
Frequently asked questions
Does Medicare cover nursing home costs?
Medicare does not cover nursing home stays if the only care you need is help with daily activities. It also does not cover long-term nursing home care. If you're admitted into a skilled nursing facility after a hospital stay, Medicare provides coverage for up to 100 days, although you'll have to pay a deductible and a daily fee.
How much does a nursing home cost?
Nursing homes cost an average of $94,900 per year for a semi-private room and $108,405 per year for a private room, according to Genworth Financial. The state you live in affects how much you'll pay, and costs vary greatly.
What happens when Medicare stops paying for nursing home care?
Medicare Part A will stop paying for skilled nursing facility care after 100 days. If you're still getting care at that point, you'll be responsible for paying the full cost. You may want to consider other types of coverage and programs that can help lower the cost of medical care.
Sources
Sources include the Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services Administration on Aging, the Department of Veterans Affairs (VA), Genworth Financial, the Iowa Long-Term Care Partnership and Medicare.gov.
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