As a general rule, Original Medicare (Part A and Part B) does not cover nursing home care, but it may cover skilled nursing care under certain circumstances.
Medicare covers services and supplies that are considered to be medically necessary. If a beneficiary requires skilled nursing care and not just custodial care (help with bathing, dressing, or eating), then they may qualify for Medicare coverage of nursing home care. Medicare will not cover custodial nursing home care.
Medicare covers certain instances of skilled nursing care. Skilled care is given when beneficiaries need skilled nursing or staff to observe, manage, or evaluate their care. This regularly occurs after hospitalization, and may include physical therapy and intravenous injections.
How does Medicare cover nursing home care?
Medicare covers up to 100 days in a Skilled Nursing Facility (SNF) if you continue to meet the requirements. The following is specifically covered:
- During days 1-20, Medicare covers the full cost of covered services and you pay nothing.
- During days 21-100, Medicare covers all costs of covered services except a daily copayment, which you are responsible for paying.
- During the days beyond 100, Medicare pays nothing and you are responsible for the full cost of services.
In order for Medicare to provide this coverage, all of the following must be true:
- You have Medicare Part A and have days left in your benefit period to use toward skilled care.
- You have an inpatient hospital stay of at least 3 consecutive days (this is considered a qualifying hospital stay, so your skilled care after this hospitalization is covered).
- Your doctor has ordered skilled care.
- You require the skilled care on a daily basis.
What care does Medicare not cover?
Medicare does not cover custodial care, which may be required for longer periods of time following a hospitalization. This is the type of care required when beneficiaries need assistance with daily activities, such as getting in and out of bed, dressing, bathing, eating, or using the bathroom. This care is often given in a nursing home facility, but Medicare will not cover it.
To learn more about Medicare coverage of nursing home care, watch the video below:
Medicare has neither reviewed nor endorsed this information.