Reviewed by Letha Sgritta McDowellLetha Sgritta McDowell is an attorney practicing in both Virginia and North Carolina. She is a fellow of the American College of Trusts and Estates Council, a certified elder law attorney, and a past president of the National Academy of Elder Law Attorneys.

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Moving an aging parent to a nursing home can be complicated decision. While families often focus on finding the best care option for their loved one, considering the costs cannot be avoided. On average, the yearly price tag of a nursing home can stretch to over $100,000 according to Genworth. Medicare doesn’t cover long-term care in a nursing home, but it may pay for short-term stays in a skilled nursing facility (SNF) and some costs of medically necessary services.

Key Takeaways

Medicare doesn’t cover long-term care in a nursing home. However, it will cover short-term stays in skilled nursing facilities (SNFs) for qualified individuals.
Nursing home and skilled nursing facilities are different. Generally, nursing homes provide long-term care whereas SNFs offer short-term care for individuals recovering from an illness or injury.
Medicare is federal health insurance for seniors or younger individuals with disabilities or certain illnesses. There are two parts of Original Medicare while Medicare Advantage Plans are offered through private insurance companies.
Medicare can help seniors by paying for some medical care. Medicare will cover services such as durable medical equipment, limited drug therapy, and hospital stays for qualified seniors.

Does Medicare cover nursing homes?

Long-term care provided in a nursing home is not covered by Medicare. However, temporary, medically necessary care prescribed by a doctor is covered under Part A in a Medicare-certified skilled nursing facility.^[01] Note that a senior must meet specific eligibility requirements to qualify for this coverage.

Medicare Part B will cover the costs of some services a senior receives while living in a nursing home, a 20% copayment may be required for some items and services, including the following:

Services from health care providers such as doctors, clinical nurses, and occupational therapists ^[02]
Durable medical equipment approved for use by a doctor ^[03]
Limited outpatient and inpatient drugs
Ambulance services

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How much will Medicare pay for a nursing home?

Medicare only covers short-term stays in Medicare-certified skilled nursing facilities. It will not pay for long-term care in a nursing home. If your loved one qualifies for temporary care in a skilled nursing facility, Medicare will pay at least some of the costs for up to 100 days.^[01]

Medicare will pay the full cost of covered services for days 1-20.
The patient pays a daily coinsurance for days 21-100, and Medicare covers the remaining costs for covered services.
Beyond day 100, Medicare does not cover any costs. The patient is responsible for the full cost of services.

It’s important to confirm that the facility your loved one is referred to — or that you find on your own — is Medicare-certified. Medicare-certified skilled nursing facilities submit claims to Medicare for services provided. Medicare then pays the facility directly for covered services. Any coinsurance or charges for services not covered by Medicare are usually billed to the patient after the facility receives payment from Medicare.^[04]

While facilities are required to provide notice of services that are not covered by Medicare before care begins, make sure to review and clarify what services are being provided and what is and is not covered.

Medicare is the federal health insurance program for people age 65 or older and younger people with certain disabilities and illnesses that include end-stage renal disease or amyotrophic lateral sclerosis (ALS).^[01]

Original Medicare

Original Medicare has two parts to cover different types of care.

Part A (hospital insurance) helps cover inpatient stays at a hospital or skilled nursing facility and home health care.
Part B (medical insurance) focuses on medically necessary services a patient may receive from a doctor or other medical professionals. It may also cover some preventative services and medical equipment a patient may need.

Medicare Advantage

Medicare Advantage plans offer the same basic coverage as Original Medicare but through private insurance providers. These plans may offer additional benefits, but they can also come with their own set of restrictions. While Medicare Advantage plans vary by provider, they don’t typically cover long-term care in a nursing home.

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Nursing home or skilled nursing facility?

“Nursing home” is often used as an umbrella term to describe a variety of residential senior living communities. However, a nursing home is typically a long-term care facility that provides 24/7 supervision, medical services, and assistance with personal care. Nursing homes are usually staffed by medical professionals including registered nurses (RN), licensed practical nurses (LPN), and occupational therapists.

Skilled nursing facilities (SNFs) provide short-term care for people who are transitioning out of a hospital after an illness or injury and require support before returning home. Like nursing homes, SNFs are staffed by medical professionals who support medical and personal care needs and rehabilitation.

Finding a nursing home or skilled nursing facility can be confusing. It’s common for nursing homes to provide both short-term skilled nursing services and long-term residential care. However, keep in mind that Medicare will not pay for long-term care in any setting.

Other payment and care options for families

Medicare doesn’t cover long-term care in a nursing home, but there are several ways to pay for senior care, including savings, Medicaid, veterans benefits, long-term care insurance, and funds from a life insurance policy.

For some families, Medicare-covered home health care may work as an alternative to a nursing home. Individuals who meet Medicare’s eligibility requirements for home health care can receive up to 35 hours of services each week.^[05]

Navigating Medicare can be challenging, but the official Medicare site offers support for signing up and understanding the coverage your loved one may qualify for.

For assistance learning about other senior living options in your area, contact a Senior Care Advisor. As senior living experts, they can provide guidance while helping you find the care that fits your loved one’s needs.

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References

Centers for Medicare & Medicaid services. Medicare coverage of skilled nursing facility care.
Medicare.gov. Doctor & other health care provider services.
Medicare.gov. Durable medical equipment (DME) coverage.
Medicare.gov. Does your provider accept Medicare as full payment?
Centers for Medicare & Medicaid services. Medicare and home health care.

Meet the Author

Kevin Ryan

Kevin Ryan is a copywriter at OurParents. He has written about Medicaid and Medicare, and focuses on creating content for caregivers. Previously, Kevin worked as a freelance writer, a special education teacher, and a counselor for adults with developmental disabilities. He earned a bachelor's degree from the University of Colorado Boulder.

Edited byKristin Carroll

Reviewed byLetha Sgritta McDowell

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

Does Medicare Pay for Nursing Homes?