Does Medicare Cover Nursing Homes?

When a person needs extra care but not necessarily from a hospital, a nursing home may be a suitable option for them. Most nursing homes provide extra care throughout the day. The care that you will receive will vary depending on your medical condition or the help that you will need.

Many looking into a nursing home my have the question, “does Medicare cover nursing homes?” In this article, we answer that question in clear, plain English. You will also find the average costs of skilled nursing facilities and other helpful info.

Does Medicare Cover Nursing Homes?

The short answer is yes; Medicare will cover the cost of nursing homes. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your stay in a nursing home. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for nursing home stays. Coverage for skilled nursing facilities is provided by Medicare Part A. However, for Medicare Part A to provide coverage for skilled nursing facility stay, you must meet these conditions:

Before being transferred to the nursing home, the patient must have been formally admitted to a hospital as an inpatient for three consecutive days
The patient must enter a skilled nursing facility within 30 days of leaving the hospital
The patient must enter the nursing home within 30 days of being discharged to a hospital
The nursing home must be Medicare-approved
The patient must receive the same treatment that he/she received during his/her hospital stay. He/she must also be given 24/7 care
If the patient needs therapy services, they should be given at least five days a week

Medicare Part A also provides coverage for treatment and care for a medical condition that the patient develops during his/her stay at a nursing home.

Services that Medicare covers during a stay at a nursing home include:

Ambulance transportation
Medical social services
Medical supplies and equipment that are used in the facility
Prescription drugs
Meals
Dietary counseling
Swing bed services
Semi-private room
Occupational therapy
Physical therapy
Speech-language pathology services
Skilled nursing care

However, Medicare Part A will only provide coverage for short-term stays in a nursing home. They will not provide coverage for long-term stays or custodial care.

Medicare Part A’s coverage will change the longer you stay in a nursing home. For the first 20 days, Medicare Part A will cover 100 percent of the costs of your stay in a nursing home.

From days 21 to 100, Medicare will still provide coverage for your stay in a nursing home, but you will pay a copay of $185.50 a day.

After 100 days of stay in a nursing home, Medicare Part A will no longer provide coverage. Your benefit period will reset after 60 consecutive days of being released from a nursing home.

Part C Coverage for Nursing Homes

Medicare Advantage plans (Medicare Part C) also provide coverage for nursing homes. They cover everything Original Medicare covers, but will usually also offer additional benefits. However, exactly what it covers and how much you’ll pay out-of-pocket for treatments and services will vary depending on the specifics of your plan.

How Much Does It Cost To Stay In A Nursing Home?

A private room in a skilled nursing facility may cost $290 per day and $8,800 per month, while semi-private rooms cost $255 per day and $7,800 per month.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.