Many beneficiaries make the mistake of assuming that Medicare pays for nursing homes. Unfortunately, this isn’t true. But Medicare will pay for nearly identical care on a short-term basis. If you need help paying for a nursing home, keep reading. There are cost-saving alternatives other than Medicare.

Types of Nursing Home Care Covered by Medicare

Certain types of short-term care can be covered by your Medicare Part A hospital benefits. Medicare Part A provides up to 100 days of coverage for these incidents. You must meet the following criteria first, though:

  • Require inpatient hospitalization treatment for at least 3 days
  • Have your doctor admit you to a Skilled Nursing Facility within 30 days of hospital discharge
  • The care you receive in your nursing home must be for the same condition you received care for in the hospital

Your doctor must certify that you need skilled nursing care in a nursing home from a qualifying health care professional which cannot be equaled with outpatient treatment

Types of Care Not Covered by Medicare

If the care you receive in your nursing home comes from a qualified medical professional with a degree, Part A will cover it. But if you need help with any of the following, you’ll likely be paying out-of-pocket for those services:

  • Personal hygiene needs
  • Feeding yourself
  • Dressing yourself
  • Keeping your space clean
  • Personal mobility
  • Any other assistance which doesn’t require medical training to administer

How Long Does Medicare Pay for Nursing Home Care?

The different parts of Medicare have different benefit periods. Your Medicare Part B benefit period is annual; it resets every year. But the Medicare Part A benefit period is tricky. Here’s how these benefit periods typically work:

  1. It begins on the first day that you’re admitted for inpatient hospital treatment at a qualifying facility
  2. You start with a $1,556 deductible that you must pay each benefit period
  3. The first 60 days of care will be 100% paid for by Medicare
  4. On day 61, you must pay [GCBB#part-a-inpatient-coinsurance-days-61-90] per day in coinsurance fees until the end of your benefit period
  5. You can receive up to 100 days of treatment in that facility before your Medicare Part A benefits are exhausted
  6. Starting on day 101, all of your costs are 100% your responsibility
  7. Once you’re discharged from the facility, you have to wait 60 consecutive days before your next benefit period begins
  8. Once you hit that 60-day threshold, you can be readmitted and start a brand new benefit period
  9. If you require daily nursing home care, cycling in for 100 days and out for 60 days at a time isn’t feasible. So you’ll have to look towards alternative options.

Other Ways to Pay for Nursing Home Care

It’s unfortunate that Original Medicare provides so little help. But it’s not impossible to get financial assistance for this type of care. Below are some ways that you can help yourself (or an older loved one) reduce the onerous financial burden of nursing home costs.

Medicare Supplement Insurance

The main two types of Medicare Supplement Insurance available are Medigap policies and Medicare Advantage policies (Medicare Part C). Certain deluxe Medicare Advantage plans with lots of bells and whistles may help provide financial assistance or reimbursement for nursing home care. But you’ll have to talk to your provider to get all the details.

Every Medigap plan will pay for Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted. But only plans B through N will help you take care of your Part A deductible. Furthermore, Plan L will only pay for 75% of those out-of-pocket costs. Plans K and M will only pay for 50% of your out-of-pocket costs.

Medicaid and Nursing Home Care

If you cannot afford to pay out of pocket for your own nursing home care or for the care of an older loved one, you can apply for Medicaid. In order to get approved, you have to prove the following:

  • That you or your loved one has a very low income
  • That you or your loved one doesn’t possess any assets that you could liquidate in order to pay for the cost of care

Unlike Medicare, Medicaid is a state government program which means that qualifying for it — and the amount of help you receive — will vary from one state to the next. It’s best to directly contact your local CMS office for help with your Medicaid application.

FAQs

What does Medicare Part B cover in a nursing home?

Part B usually covers nothing toward the cost of a nursing home. If it’s covered at all, it will be by Part A.

What happens when you run out of Medicare days?

Medicare will stop paying for your benefits once you run out of days. The way to get your benefits to reset is to be out of the nursing home for 60 consecutive days.

Does Medicare cover assisted living?

Medicare does not take care of any bills associated with the cost of assisted living.

Looking for Coverage for Your Nursing Home Expenses?

Figuring out how to care for yourself when nursing home care becomes necessary can be difficult. It’s especially hard to get financial help from Medicare for that specific type of care.

But our licensed insurance agents are more than willing to consult with you about coverage and options. The agents can help you look into Medicare Supplemental plans that could assist in extending benefits for this type of care.

Our agents’ time is free of charge for you, so give us a call today. Or fill out our convenient and quick online rate form to be connected with the best rates in your area.

Picture of the author
by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.