Does Medicare or Medicaid Cover Nursing Homes?

Does Medicare Cover Nursing Homes?

Medicare may cover some nursing home costs, but only for short, approved visits. Medicare Part A (hospital insurance) covers some specific, short-term services within a skilled nursing facility (or at home), as long as they are deemed medically necessary. For example, Medicare may cover skilled treatment for an injury or illness in a nursing home.

Original Medicare (Part A and Part B) only pays for nursing home care up to a maximum of 100 days (the average stay is 22 days). Some Medicare Advantage plans (Part C) may also offer partial coverage, but only if the nursing home contracts with that plan. You can visit our Medicare Advantage search tool to find plans in your area and learn more about coverage options.

Medicare does not cover long-term nursing home care, AKA custodial care. It includes routine, sometimes “unskilled” services like help with bathing, dressing, or bathroom use. Medicare may cover a limited number of services within nursing homes for patients who meet specific criteria.

What Is Covered by Medicare

• Medical and nursing care for up to 100 days in a skilled nursing facility
• Prescription medication covered under Medicare Part A
• Room and meals

What Is Not Covered by Medicare

• Long-term, custodial care
• Dental care
• Routine eye exams
• Cosmetic procedures
• Hearing aids and related exams
• Routine podiatry (foot care)

To learn more, watch our video below on the things that Medicare won’t cover.

Eligibility Requirements

• Enrolled in Medicare Part A (hospital insurance)
• Available days in your benefit period
• Qualifying hospital stay: three or more days hospitalized as an inpatient (unless waived by COVID-19 Medicare3 policy)
• Enter a Medicare-approved facility within 30 days of qualifying hospital stay
• A doctor determines you need daily skilled care
• The skilled nursing facility is Medicare-approved
• A hospital-related medical condition treated during a qualifying stay

How Much Does Medicare Cover for Nursing Homes?

Original Medicare nursing home coverage is intended for rehabilitation, not long-term care. It only covers a portion of nursing home expenses for up to 100 days. Medicare calculates nursing home rates by period, so your out-of-pocket cost changes over time. Below is a breakdown of what you may pay per benefit period during those 100 days:

• Days 1-20: $0 (Medicare pays 100 percent)
• Days 21-100: Up to $200 per day coinsurance4
• Days 101 and beyond: All expenses (Medicare covers 0 percent)

What Happens when Medicare Stops Paying for Nursing Home Care?

Medicare nursing home benefits run out after 100 days (per illness). Therefore, it’s essential to know your longer-term options. When Medicare stops paying, you may want to have one of the following alternatives in place:

Medicaid

Both federally and state-funded, Medicaid helps cover medical costs for people with limited incomes. Income and asset limits vary by state, but most people don’t qualify for Medicaid instantaneously. They often start paying for nursing homes with private insurance and personal funds. If you do qualify, Medicaid covers most basic long-term health care costs. Remember that not all nursing homes accept Medicaid, so confirm with the facility beforehand.

In addition to income, Medicaid also takes some (not all) of your assets into account, including bank balances, CDs, stocks and bonds, secondary property (non-primary residences), and non-primary vehicles. You can check Medicaid eligibility and find approved providers for your state on Medicaid’s website.

Private Long-Term Care (LTC) Insurance

You can buy insurance policies to cover many long-term health care costs. Policy choices (and premiums) vary considerably. Some just cover nursing home care, while others cover everything from adult day care to medical equipment. But buyers beware:

• Only buy from a reputable carrier licensed in your state.
• If you have a preexisting condition, ask if coverage is limited or more expensive.
• Check for discounts, as retirees, veterans, and government employees may qualify for group rates.

Personal Funds

Many people start paying for nursing home care with their savings and/or through LTC insurance. Even with Medicaid, Medicare, and private insurance, most families ultimately pay for at least some nursing home expenses out of pocket. For this reason, it is vitally important to begin saving for future nursing home costs as soon as possible.

How to Find Nursing Homes that Accept Medicare Near Me

Here are a few tips for finding the right nursing home for your needs:

• If you like your doctor, ask if they provide services for any local nursing homes.
• Ask friends, family, and colleagues you trust if they or their family members have had good experiences with a particular nursing home.
• Search for locally certified nursing homes.
• Search Medicare’s eldercare locator.
• Poll your local senior community center.
• While in the hospital, talk to a social worker about post-discharge care plans.
• For extra guidance, call or chat with Medicaid.

Does Medicaid Cover Nursing Homes?

Medicaid covers nursing home costs if you qualify and is the largest fund source for nursing home care. For those who are eligible, Medicaid covers long-term nursing home care in Medicaid-certified facilities4 when medically necessary. You’ll have to be under a certain income level and meet other state-specific requirements to qualify.5

All 50 states offer Medicaid, but nursing home services, cost coverage, and eligibility requirements vary widely by state. For example, each state sets its own income limit to determine if you are eligible for Medicaid.

Unlike Medicare, Medicaid does not impose an official time limit on nursing home stays as long as they’re in a licensed and certified Medicaid nursing facility. Generally, you can expect Medicaid to cover all of the following:

• Long-term care (health-related only) covers nursing home stays for qualifying patients needing ongoing care for a chronic mental or physical condition.
• Skilled nursing and related medical care.
• Rehabilitation from illness, injury, or disability.

How Much Does Medicaid Pay Towards a Nursing Home?

Some Medicaid services are paid for in full, but others are not. Individual states manage their own Medicaid programs, so the level of coverage depends on your facility’s location. For example, certain states might cover routine dental services or have higher cost allowances. That said, the federal government does require Medicaid-certified nursing homes to provide the same minimum services.

What Is Covered by Medicaid*

• Nursing services
• Room and board
• Dietary services
• Medically-related social services
• Pharmaceutical services
• Routine hygiene products and assistance
• Dental (routine and emergency dental up to state limit)
• Professionally directed activities
• Specialized rehabilitation (for mental illness or disability)

*Level of service varies by state

What Is Not Covered by Medicaid

• Private rooms (unless medically necessary)
• Clothing
• Special food (beyond what the facility already prepares)
• Personal comfort items (telephone, TV, radio, computers, reading materials, tobacco, alcohol, flowers and plants, etc.)
• Cosmetics or extra grooming products
• Social activities beyond the facility’s activity program
• Special care outside Medicaid-contracted coverage

How to Find Nursing Homes That Accept Medicaid Near Me

Below are a few resources and tips for finding a Medicaid-approved nursing home in your area.

• Use Medicaid’s search tool to look for pre-vetted facilities by ZIP code.
• Ask your doctors if they service any Medicaid-certified nursing homes.
• Ask friends, family, and colleagues you trust.
• Contact an Aging and Disability Resource Center (ADRC).
• If you’re in the hospital, talk to a social worker about post-discharge care planning; they may be affiliated with or know reputable, certified Medicaid nursing homes.

As you can see, funding nursing home expenses with Medicare or Medicaid alone can be tricky. Most of the time, you must supplement your government health care coverage with private funds or additional insurance. Remember to consult with your family and a trusted financial planner before deciding for yourself or a loved one.