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Does Medicare Pay for Nursing Homes?

En español | No, Medicare does not 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 does not pay for a stay in a long-term care center or the cost of custodial care — help with the activities of daily living, such as bathing, dressing, eating and using the bathroom — if that is the only care you need.

Medicare covers some short-term stays for skilled nursing

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 to 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 that 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 are being officially admitted or if you are there only for observation. That will be important in determining the beginning of your benefit period, which begins the day you are admitted to a hospital as an inpatient or become a patient in a skilled nursing facility, and ends when you’ve been out of those places for 60 days in a row. These rules also 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.

What skilled nursing facility costs does Medicare cover?

Medicare can cover many of the services you receive in a skilled nursing facility, such as:

  • A semiprivate room and meals
  • Skilled nursing care
  • Medical social services and dietary counseling
  • Medications, medical equipment and supplies used in the facility
  • Occupational therapy, physical therapy or speech and language pathology services if needed to meet your health goal
  • Ambulance transportation if needed to receive necessary services that aren’t available in the facility

How much do I pay if I’m in a skilled nursing facility?

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:

  • $0 for days 1 to 20
  • $194.50 a day in 2022 for days 21 to 100
  • All costs days 101 and beyond 

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.

Keep in mind

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 payouts, you generally must need help with at least two activities of daily living (ADLs) 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 July 19, 2022

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