Medicare is the federal government’s national health insurance program. It does not usually cover long-term nursing home costs, but some plans may fund temporary stays in a skilled nursing facility (SNF) if a person needs specialized care.
Medicare has four parts that cover healthcare services, including hospital treatment, outpatient care, and prescription drugs. Understanding what each plan includes can make it easier to seek and receive healthcare.
This article looks at how Medicare can help with some nursing home costs, what help is available for hospice care insurance, and how to find a nursing home.
According to the Centers for Disease Control and Prevention (CDC), around 1.3 million adults in the United States live in a nursing home. Medicare classifies nursing home care as either skilled or custodial.
As a general rule, Medicare Part A covers a person for 100 days of acute care in an SNF. Every day, the individual must receive skilled care that is necessary for their recovery.
A person with professional medical training, such as a registered nurse or physical therapist, delivers this level of care. Doctors generally expect that people in an SNF will recover from their illness or injury.
Medicare does not cover custodial care for people who need ongoing help with essential activities, such as eating, bathing, or dressing. Custodial, or nonmedical, care usually means a continuous, long-term stay in a nursing home.
Providing daily care for older adults and people with disabilities is an important skill. However, those who provide custodial care are not technically trained doctors or medical professionals.
It is helpful to understand which parts of Medicare may assist with nursing home costs. Here is a summary of what Medicare may cover:
- Medicare Part A: This part covers in-hospital treatment, but it may also cover short-term care in an SNF, including medications.
- Medicare Part B: This covers outpatient services. It does not usually provide funding for stays in nursing homes.
- Medicare Part C: This is a bundled plan that private companies administer. It is also known as Medicare Advantage. It does not usually cover long-term custodial nursing home care. However, coverage often depends on the company providing the plan, so there may be exceptions.
- Medicare Part D: This covers the cost of some or all of the prescription drugs for people who live long-term in a custodial nursing home.
If a person is recovering from an illness, accident, or medical procedure, Medicare Part A could provide coverage for a stay in an SNF.
A doctor must verify that the person requires daily skilled nursing care. The person must also have days left in their benefit period.
For example, if they have used all 100 days of SNF care, they would not be eligible for further coverage.
They must also:
- choose a Medicare-certified SNF
- enter the SNF no later than 30 days after a hospital stay of more than 3 days
- receive skilled care for the original health problem for which they received treatment in the hospital or for a condition that developed while they were in the hospital
Here are some services that Medicare Part A may cover in an SNF:
- a semi-private room, which usually means that the person shares with one other
- ambulance transportation to providers of healthcare services that are not available at the SNF
- dietary counseling and nutrition services
- medical social services
- medical supplies and equipment
- occupational therapy
- physical therapy
- skilled nursing care, such as intravenous injections
- speech-language pathology
- swing bed service, which means that an individual receives SNF care in an acute care hospital
Medicare covers up to 100 days of SNF care each benefit period.
These are the payments due for short-term SNF care:
- Days 1–20: Medicare covers the full amount. The insured person pays nothing for each benefit period.
- Days 21–100: The insured person pays a $176 coinsurance per day for each benefit period.
- Days 101 and beyond: The insured person must pay the full costs.
If a person needs services that Medicare does not cover, they may have to pay more.
Medicare supplement, or Medigap, policies are plans that private insurance companies offer.
For an extra monthly premium, Medigap helps reduce out-of-pocket costs, such as copayments and deductibles, that Medicare parts A and B do not cover. It can help a person cover the daily coinsurance in the 21–100-day window of nursing care.
Federal law defines 10 Medigap plans. Some of them may help a person pay for the SNF coinsurance. However, individual states regulate the plans, and not all plans are available in each state.
Medigap plans do not pay for long-term nursing home care.
Usually, Medicare parts A and B do not cover custodial nursing home care.
Medicare Part C may pay for healthcare or prescription medications while a person stays in a nursing home. A Special Needs Plan can help people with certain conditions or healthcare needs.
It is best to contact the plan provider directly for information on which services Medicare Advantage plans cover and which copay charges may apply.
Medicare Part D can help a person fund prescription drug coverage while they live in a nursing home. A long-term care pharmacy that works with the Medicare plan will provide the medications.
If a family member has Alzheimer’s disease or another terminal condition, and a doctor certifies that they have fewer than 6 months to live, Medicare could offer a hospice benefit.
Hospice care offers comfort to people who are at the end of their lives and support for their families. Care focuses on reducing pain and providing counseling.
Medicare plans cover hospice admission if the enrolled person accepts palliative care instead of care that focuses on recovery. They must also sign a statement choosing hospice care.
Medicare will pay for hospice care delivered in the home, a nursing facility, or an inpatient hospice facility. It can help with the costs of medication and offers assistance with caregiving.
Most people who live in a nursing home will need to pay for their care out-of-pocket from private resources.
The Medicaid program may be able to help people with limited resources who need a nursing home. However, not all nursing homes accept Medicaid payments.
A person’s social security benefit will not help with nursing home costs, but some older adults may be eligible for supplemental security income in addition to their social security, which could help fund nursing home care. This is a needs-based program. A person can find out if they are eligible by researching the social security disability program.
Private insurance companies offer long-term care policies that can pay for skilled and non-skilled care. The terms of these policies may vary depending on the provider.
Some may cover nursing home care. Others include cover for a range of medical services. An existing life insurance policy may also provide cover for long-term care.
Medicare provides a database called Nursing Home Compare that contains the details of every Medicare-certified nursing home in the country.
This database can help a person locate suitable nursing home care.
Medicare Part A can cover some costs associated with skilled nursing care in a nursing home if the individual meets specific requirements.
If a person needs long-term custodial care in a nursing home, they must pay out-of-pocket expenses. Medicaid or long-term care insurance may be able to help with the costs.
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