Does Medicare Pay for a Nursing Home?
Unfortunately, Original Medicare doesn’t cover the cost of a long-term stay at a nursing home, but certain parts of Medicare can pay for “medically necessary” or essential services at nursing homes. Some of these services include meal preparation, prescription drugs, durable medical equipment, counseling, and other services. Overall, Original Medicare covers short-term visits, but not long-term stays.
Medicare Part A
Although Original Medicare doesn’t generally pick up the cost of nursing homes, Part A might be able to help offset some costs. Medicare Part A (Hospital Insurance) typically covers skilled nursing facility care or nursing home care — with the exception that it’s neither custodial nor long-term.
You may be able to receive coverage through Medicare Part A if a physician deems it is “medically necessary” for you to have skilled nursing care. According to Medicare, Medicare Part A can cover inpatient hospital stays, a skilled nursing facility, hospice care, and some home health care services. For example, Medicare Part A can cover wound care or medication management in an inpatient hospital care setting. Some of the most common services that can be covered by Medicare Part A include prescription medications, changing sterile dressings, or nutrition-related services and meals.
Medicare Part B
Although Medicare Part B can’t cover the full cost of nursing homes, it can help cover chiropractic care, in addition to oxygen tanks and other durable medical equipment.
Part B, or Medical Insurance, covers most diagnostic and treatment services and outpatient hospital services such as an emergency room stay or X-rays. Medicare Part B will cover 80 percent of the cost of medically necessary services, while you’d be responsible for the remaining out-of-pocket 20 percent.
Although Medicare Advantage covers nursing homes in the same way as Original Medicare, it can provide extra coverage for other services related to vision, hearing, or dental. It can also cover fitness programs for seniors. Depending on your Medicare Advantage plan, you may even receive coverage for services such as doctor visits, over-the-counter drugs, and transportation. I’d recommend reaching out to your particular Medicare Advantage plan to see if nursing home care can be covered.
Medicare Part D
Medicare Part D, or Prescription Drug Coverage, can help cover the cost of prescription medications that you need while at a nursing home. Although it can’t cover nursing home costs, it can cover some medically necessary services. In order to enroll in Medicare Part D, you’ll need Medicare Part A or B.
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Some Medicare Advantage and Medigap plans work by covering gaps in Original Medicare. Skilled nursing care might be covered under Medigap. Check with your Medigap plan to see what’s covered. Typically, your Medigap might be able to cover the cost of a skilled nursing facility if you need it for longer than 100 days.
To learn more about Medicaid and Medigap coverage, read our guide: Medigap vs. Medicaid.