January 16th 2025
By Ari Parker
Learn when Medicare covers nursing home stays, what you'll pay, and how to get help with long-term care costs when Medicare doesn't cover them.
By Ari Parker
Many of us worry about the cost of nursing home care as we age. While Medicare can help pay for short-term nursing home stays after a hospital visit, it doesn't cover long-term care or living costs.
Let's look at what Medicare does and doesn't cover in regards to nursing home care.
Nursing home care at a skilled nursing facility (SNF), provides 24-hour medical and personal care for individuals who cannot care for themselves at home. This includes:
Skilled nursing care (e.g., wound care, medication administration)
Physical, occupational, and speech therapy
Assistance with custodial care for the activities of daily living (ADLs) like bathing, dressing, and eating
How does an SNF differ from assisted living? Assisted living is a long-term housing situation that many seniors embrace when they need help managing daily activities. Medicare usually does not pay for assisted living costs. Learn more about the differences between assisted living and nursing homes.
Medicare will only cover your care in a skilled nursing facility (SNF) when you need short-term medical care and rehabilitation after a qualifying hospital stay.
Think of nursing home care in two ways: short-term rehabilitation and long-term residence. A facility can offer both types of care, but Medicare only covers the short-term rehabilitation. This means Medicare won't pay for:
Permanent residence in a nursing home, even if you need 24/7 SNF care
Long-term custodial care (help with daily activities like bathing or dressing)
Room and board costs
If you need to live in a nursing home permanently, you'll need to pay for the cost of residence through other means. Some options include private insurance, veterans benefits, personal funds, or Medicaid. Medicare will not cover long-term care services under any circumstances.
Sometimes you need extra care after surgery or while recovering from an illness or accident. A skilled nursing facility can provide the medical care and physical therapy you need to recover.
Medicare will help pay for your nursing home costs, but only when you meet all three of these requirements:
Your doctor must certify that you need skilled nursing care or physical therapy every day
You must choose a Medicare-certified facility
You must enter the facility within 30 days of spending at least 3 days in the hospital
Both Medicare Part A and Part B help cover nursing home costs when you meet these three requirements.
During your stay at a skilled nursing facility (SNF), Medicare Part A generally covers medications that are part of your treatment plan. For any prescription drugs you need to take at home or during an uncovered nursing home stay, Medicare Part D coverage should help cover those.
If you meet the eligibility requirements, Medicare Part A can cover up to 100 days of care in a skilled nursing facility (SNF). This coverage works using what Medicare calls a 'benefit period.'
A benefit period starts the day you enter a hospital or SNF as an inpatient. It ends when you've been out of both the hospital or SNF for 60 consecutive days. Each new benefit period gives you a fresh set of 100 days of potential coverage for your nursing home stay.
Medicare Part A will cover care during a benefit period as follows:
Days 1-60: Medicare pays all costs after you meet your deductible.
Days 61-90: You pay a daily coinsurance amount.
Days 91-150: You pay a higher daily coinsurance amount for up to 60 lifetime reserve days.
Once you use all your lifetime reserve days, you are responsible for the full cost of your hospital stay. Your Medicare supplement (Medigap) may cover copayments that Original Medicare will not.
You can have multiple benefit periods in a year.
You must be out of the hospital or SNF for 60 consecutive days to start a new benefit period.
You are responsible for whatever out-of-pocket costs Medicare doesn’t cover.
Medicare Part B covers certain medical services provided in a nursing home, such as:
Doctor visits, whether a physician comes to you or you are transported to see one
Medical supplies needed for your care
Certain therapies, such as speech, physical, or occupational therapy
Medicare Part C, known as Medicare Advantage, is an alternative to Original Medicare. It has similar coverage to Original Medicare when it comes to nursing home care. Medicare Advantage plans cover skilled care in a nursing home, which includes medical services like wound care, medication administration, and physical therapy for a specific time. The details and copays vary by plan, so check your plan or discuss your needs with a Medicare advisor.
The 1.2 million Americans living in nursing homes usually have ongoing medical needs. According to federal guidelines, nursing homes must, at the minimum, provide the following:
24-hour access to skilled nursing staff, with staff on-site for eight hours a day and on-call for remaining hours
Medical treatment supervised by a licensed physician
Services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of patients
Staff are on hand to provide assistance with daily activities such as bathing and dressing. Recent research shows that personnel spent a national average of 4.1 hours attending to each resident per day.
SNFs, on the other hand, offer special services to their short-term patients that can only be performed by licensed nurses.
Both SNFs and nursing homes are regulated by federal and state personnel.
Seniors with disabilities or ongoing medical issues who need help with the activities of daily living might consider living in nursing homes or assisted living communities. Costs vary widely, but here are the national averages according to the annual Genworth Financial survey:
Assisted living facilities: $5,350/mo
Nursing home facilities:
Semi-Private Room: $8,669/mo
Private Room: $9,733/mo
The above figures only include room and board.
These high costs lead many families to, instead, enable their loved ones to age in place by providing care at home. This can be especially important for older adults who rely solely on Social Security income, as these benefits often aren't enough to cover nursing home or assisted living expenses.
If you're homebound and need outpatient skilled nursing care or therapy, Medicare Part A and Part B can help cover for home health care services.
Medicare doesn't cover most daily personal care costs, such as help with bathing, household chores, or adult day care. However, if you qualify for Medicaid services, many states offer programs that can help pay for these services—and some even provide payment to family caregivers.
Medicaid can cover about 70% of nursing home costs for individuals who meet specific income and asset eligibility requirements.
Other sources of payment for nursing home care include:
Private long-term care insurance: Long-term care insurance can help cover the costs of nursing home care, but few people have this coverage.
Personal funds: Individuals may use their own savings or investments to pay for nursing home care.
As the cost of nursing home care can be substantial, many people need financial assistance to afford long-term care.
Have more questions about what Medicare does and doesn’t cover when it comes to nursing home care? Speak with one of our independent Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.
