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En español | No, Medicare doesn’t cover any type of long-term care, whether in nursing homes, assisted living communities or your own home.
Medicare does cover medical services in these settings. But it doesn’t pay for a stay in a long-term care center or the cost of custodial care, which may include assistance with the activities of daily living (ADL), such as bathing, dressing, eating and using the bathroom — if that’s the only care you need.
Medicare Part A, which covers inpatient hospital services, will pay for short-term stays in a Medicare-certified skilled nursing facility (SNF) in some situations. Your doctor may send you there to receive specialized nursing care and rehabilitation after a hospital stay.
Care in a skilled nursing facility is covered only if you had a qualifying hospital stay, meaning you were formally admitted as an inpatient to the hospital for at least three consecutive days. This is different from observation status, which doesn’t count even if you stayed in the hospital overnight.
When you enter the hospital, ask if you’re being officially admitted or if you’re there only for observation. That’s important in determining the beginning of your benefit period, which begins the day you’re admitted to a hospital as an inpatient or become a patient in a skilled nursing facility and ends when you’ve been out of the facility for 60 days in a row. These rules mean you might have more than one benefit period in a year.
You must be admitted to a skilled nursing facility within 30 days of leaving the hospital for the same illness or a condition related to it. Your doctor also must certify that you need daily skilled care from, or under the supervision of, skilled nursing or therapy staff.
Medicare can cover many of the services you receive in a skilled nursing facility, such as:
The portion of the costs that you pay depends on the duration of your eligible stay in a skilled nursing facility. You’ll have the following copayments for each benefit period:
A Medicare supplemental policy, better known as Medigap; retiree coverage; or other insurance may cover the copay for days 21 to 100 or add more coverage.
Medicare doesn’t pay for the considerable cost of long-term care in a nursing home or other facility. But you may have other options to help cover long-term care costs.
Private pay. Many individuals and families pay out of pocket or tap assets such as property or investments to pay for long-term care. If they use up those resources, Medicaid may become an option.
Long-term care insurance. Some people buy long-term care insurance that may pay for custodial care in a nursing home or assisted living facility or for a caregiver to come to their home. To qualify for a long-term care insurance payout, you’ll typically need help with at least two activities of daily living or provide evidence of cognitive impairment.
Veterans benefits. Military veterans may have access to long-term care benefits from the U.S. Department of Veterans Affairs (VA).
Medicaid. The federally financed but state-run health program that provides coverage to people with low incomes pays a considerable portion of America’s nursing home bills. Medicaid eligibility varies by state but requires strictly limited income and financial assets.
Updated February 3, 2023
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