Does Medicare Cover Nursing Home Care?
This article was updated on: 06/12/2019
Sometimes you may need a little more time with help from a health-care provider to recover from an illness or injury, and home care nursing may not be enough.
If you have Medicare, you may have help paying your nursing home costs. We hope this article will help you understand Medicare nursing home coverage and how it applies in different situations.
What’s the difference between nursing home care, long-term care, and home care nursing?
It’s important to understand the different types or nursing care Medicare may cover, as well as the ones it doesn’t, so you aren’t unexpectedly stuck paying your nursing home costs.
Nursing home care can be either skilled or custodial. Skilled nursing home care covered by Medicare is short-term and expected to help improve your condition. If you have hip replacement, for example, your doctor may recommend a couple of weeks in a skilled nursing facility for physical therapy to help you learn to walk with your new hip and recover your mobility more quickly.
Long-term care, on the other hand, is generally custodial care—help with things such as eating, bathing, toileting, and dressing. As the name suggests, it may last a period of weeks, months, or years. It is usually not covered by Medicare.
Home care nursing is generally home health care provided by a credentialed medical professional. It can be short-term while you recover from an illness or injury, or long-term if you have a serious chronic condition or have chosen hospice care. Medicare may cover home care nursing under certain situations.
Does Medicare pay for nursing home care?
If you have had a qualifying inpatient hospital stay and your doctor orders an additional period of treatment in a skilled nursing facility, Medicare Part A generally covers allowable expenses. Your Part A nursing home benefit usually covers:
- A semi-private room
- Prescription medications to treat your health condition
- Skilled nursing care
- Physical, occupational, and/or speech language therapy.
Medicare also may cover:
- A medical social worker
- Dietary counseling if indicated
- Medical equipment and devices you use during your hospital stay
- Ambulance transportation to and from the facility
There are costs for a covered stay in a skilled nursing facility (nursing home). In 2019, you pay no coinsurance for days 1 through 20, $170.50 per day for days 21 through 100, and all nursing home costs for your care after the 100th day.
Medicare does not, however, pay any nursing home costs for long-term care or custodial care. If you need unskilled care for activities of daily living, care for an extended period of time, or care that is not reasonably expected to improve your condition within a limited timeframe, Medicare will not cover it.
Does Medicare pay for home care nursing?
If you meet the requirements for home health care, Medicare generally covers part-time, intermittent home care nursing and other medical therapies, such as physical and occupational therapy. If the home care nursing follows a qualifying hospital stay, Part A may cover 100% of allowable charges.
If there was no qualifying inpatient hospital stay, Part B may still cover some home care nursing services.
Medicare typically doesn’t pay for more than eight hours a day of home care nursing, and it typically doesn’t cover services seven days a week. Medicare only covers home care nursing for a short period of time.
If you qualify for hospice care and choose hospice benefits under Part A, Medicare pays for part-time home care nursing for as long as you receive hospice care.
What are the requirements for Medicare nursing home coverage?
Before Medicare covers skilled nursing home costs, you must have a qualifying hospital stay of at least three inpatient days prior to your nursing home admission. You must have inpatient status for at least three days; time spent in the emergency department or observation unit doesn’t count toward the three-day requirement.
If you refuse nursing care or medical therapies recommended by your doctor while you are in a skilled nursing facility, you may lose your Medicare nursing home coverage.
What Medicare nursing home coverage am I eligible for if I need long-term care?
Medicare won’t pay your nursing home costs, but you still have your Part A and Part B benefits while you’re in a nursing home. For example, Part B covers your doctor visits and medical therapy visits, and if you need hospital care, Part A benefits apply. If you have a Part D Prescription Drug Plan, the medications you take in the nursing home are usually covered. You may have to enroll in a plan that works with your nursing home pharmacy, but the facility should help you choose the right coverage.
If you live in a nursing home, you may be able to enroll in a Medicare Advantage Special Needs Plan, which has benefits designed to best serve residents of a long-term care facility. These plans include Part D prescription drug coverage and may be more affordable than other Medicare plans. You may also qualify for a Special Needs Plan if you are on both Medicare and Medicaid.
Do Medicare Supplement insurance plans cover nursing home costs?
Some Medicare Supplement insurance plans include increased coverage in skilled nursing facilities (beyond what Original Medicare pays for). Medicare Supplement insurance plans may cover your out-of-pocket costs for doctor visits and other medical services covered under Part A and Part B while you are a nursing home resident.
You can start comparing Medicare Advantage plans right away – just enter your zip code in the box on this page.