Does Medicare Cover Nursing Home Care?
Medicare covers short-term skilled nursing facility care after a qualifying hospital stay, for a limited time. It doesn't cover long-term custodial care, which is what most nursing home residents need.
Quick answer
Medicare covers short-term skilled nursing facility (SNF) care when specific conditions are met, typically after a qualifying inpatient hospital stay, and only for a limited number of days per benefit period, with daily coinsurance after an initial period. It doesn't cover long-term custodial care, such as help with bathing and dressing, when that's the only care needed.
Skilled vs. custodial care
| Skilled nursing care | Custodial care | |
|---|---|---|
| What it is | Daily skilled nursing or therapy, such as wound care or rehab | Help with daily activities like bathing, dressing, eating |
| Medicare coverage | Limited coverage when conditions are met | Generally not covered |
| Typical duration | Short-term recovery | Often long-term |
How Original Medicare's SNF benefit generally works
- Requires a qualifying inpatient hospital stay, and admission to a Medicare-certified SNF for a related condition.
- Covers up to a limited number of days per benefit period.
- The first days have no coinsurance; later days require daily coinsurance; after the limit, you pay all costs.
- Being in the hospital under "observation" may not count as an inpatient stay.
Medicare Advantage plans cover SNF care too, sometimes with different rules, such as waiving the prior hospital stay requirement.
Paying for long-term care
Long-term custodial care is usually paid by the individual, long-term care insurance, or Medicaid for those who qualify financially. See long-term care insurance and hybrid policies.
The takeaway
Medicare helps with short-term skilled recovery, not long-term nursing home living. Plan separately for long-term care.
Sources
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