The short answer is: Medicare may pay for a nursing home stay, but only under specific conditions.
Medicare Part A can cover a short-term stay in a skilled nursing facility (SNF) if certain requirements are met. However, it is important to note that Medicare does not cover custodial care, which is the type of care most people think of when they consider long-term nursing home stays. Custodial care includes assistance with activities of daily living (ADLs) such as bathing, dressing, and eating, which Medicare does not cover unless the care is provided in conjunction with skilled services.
Medicare Coverage for Skilled Nursing Facility Care
Medicare will pay for care in a skilled nursing facility (SNF) under the following circumstances:
1. You’ve Had a Qualifying Hospital Stay
To be eligible for Medicare coverage of a nursing home stay, you must first have had a qualifying inpatient hospital stay. This means:
- You must have been admitted to the hospital as an inpatient for at least 3 days (excluding the day of discharge) before transferring to the skilled nursing facility.
- The care you need must be skilled in nature, such as physical therapy, occupational therapy, or skilled nursing services.
2. You Need Skilled Care
Medicare Part A will cover a stay in a skilled nursing facility only if you need skilled care, which includes medically necessary services provided by a licensed professional (such as a nurse or therapist). Medicare does not pay for custodial care, which is help with daily activities that do not require skilled medical expertise, such as dressing or feeding.
3. You Are in a Medicare-Certified Facility
The nursing home must be certified by Medicare as a skilled nursing facility (SNF) to be eligible for coverage. Not all nursing homes meet this requirement, so it’s important to confirm before making arrangements.
How Long Does Medicare Cover Nursing Home Care?
If you meet the eligibility requirements, Medicare covers a portion of the cost for a stay in a skilled nursing facility, but there are limits to how long it will pay:
- Days 1–20: Medicare covers 100% of the cost of care in a skilled nursing facility.
- Days 21–100: Medicare continues to cover a large portion of the cost, but you will be responsible for a daily co-payment. For 2025, the daily co-payment is about $200 per day, though this amount is subject to change annually.
- After Day 100: Medicare stops paying for your nursing home stay, and you will be responsible for the full cost of care.
Important to Remember
- The 100 days of coverage is not an annual benefit. If you use up your 100 days of coverage, you must have a new qualifying hospital stay in order to qualify for another round of Medicare-covered care.
- You must be improving or have a specific need for skilled care during your stay. If your condition stabilizes or improves, and you no longer require skilled care, Medicare will stop paying.
What Happens After Medicare Stops Paying?
Once Medicare’s coverage ends, you are responsible for the full cost of your nursing home stay unless you qualify for other programs or assistance.
Medicaid: A Possible Option
For those who need long-term care and have exhausted their Medicare benefits, Medicaid may provide coverage for nursing home care. Medicaid is a joint federal and state program designed to assist people with limited income and resources, and it covers long-term care, including nursing home stays, in many cases.
Eligibility for Medicaid depends on income, assets, and other factors, which can vary by state. Many people rely on Medicaid after they exhaust their Medicare benefits or if they cannot afford the costs of private nursing homes.
Private Long-Term Care Insurance
Another option for covering nursing home costs is private long-term care insurance. This type of insurance is designed to help cover the costs of long-term care services, including nursing home stays, home health care, and assisted living. However, these policies can be expensive, and they typically don’t cover custodial care unless specified. It’s best to review insurance policies carefully to understand what’s covered.
Planning for Nursing Home Care
Because Medicare has significant limitations when it comes to nursing home care, it’s important to plan ahead for the possibility of needing long-term care. Here are some tips to keep in mind:
- Understand Medicare’s Limitations: Familiarize yourself with the eligibility requirements for Medicare coverage in a skilled nursing facility and the duration of coverage.
- Consider Medicaid: If you think you may need long-term care in the future, research Medicaid’s eligibility requirements and how it could help cover costs after Medicare stops paying.
- Look Into Long-Term Care Insurance: If you’re healthy and younger, it may be beneficial to purchase long-term care insurance while premiums are more affordable.
- Consult a Professional: Talk to a financial planner or elder care attorney who can help you navigate the complexities of Medicare, Medicaid, and other financial planning for potential long-term care needs.
Conclusion
Medicare can help cover some of the costs associated with a skilled nursing facility stay, but only under specific conditions such as a qualifying hospital stay, the need for skilled care, and the facility being Medicare-certified. Medicare will pay for the first 20 days in full, but after that, you’ll be responsible for a co-payment, and coverage stops entirely after 100 days.
If you need long-term care beyond what Medicare covers, Medicaid and long-term care insurance may offer additional options. By understanding the scope of Medicare’s coverage and planning ahead, you can better prepare for potential nursing home costs in the future.