Does Medicare Cover Nursing Home Care?

As we age, we may need additional care and support to maintain our quality of life. One option for those who require around-the-clock care is moving into a nursing home. However, the cost of nursing home care can be quite high, which is why many seniors and their families wonder, "Does Medicare cover nursing home care?"

What is Medicare?

Medicare is a federal health insurance program for people who are 65 years and older, some younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The program is divided into several parts, each providing coverage for different healthcare services.

Medicare Part A

Medicare Part A is often referred to as hospital insurance. It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care services.

Medicare Part B

Medicare Part B is often referred to as medical insurance. It covers doctor's services, outpatient care, medical supplies, and preventive services.

Medicare Part C

Medicare Part C, also known as Medicare Advantage, is an alternative to traditional Medicare. It is offered by private insurance companies approved by Medicare and provides all the benefits of Part A and Part B, and often includes additional benefits such as vision, dental, and hearing coverage.

Medicare Part D

Medicare Part D is prescription drug coverage. It helps cover the cost of prescription drugs and is available to everyone with Medicare.

Does Medicare Cover Nursing Home Care?

Medicare Part A covers skilled nursing facility care, but only under certain conditions:

• The patient must have a qualifying hospital stay of at least three days.
• The patient must require skilled nursing care, such as intravenous injections or physical therapy, on a daily basis.
• The patient must receive care in a Medicare-certified skilled nursing facility.

If these conditions are met, Medicare will cover the cost of skilled nursing facility care for up to 100 days. During the first 20 days, Medicare will cover the full cost. For days 21-100, the patient is responsible for a daily copayment.

It's important to note that Medicare does not cover custodial care, which includes help with daily activities such as bathing, dressing, and eating. Most nursing home care falls under the category of custodial care, which means that Medicare will not cover the cost.

What Are My Options If Medicare Doesn't Cover Nursing Home Care?

If you or a loved one needs nursing home care but Medicare does not cover it, there are several other options to consider:

• Medicaid: Medicaid is a joint federal and state program that provides healthcare coverage to people with low incomes. In most states, Medicaid covers the cost of nursing home care for eligible individuals.
• Long-term care insurance: Long-term care insurance is a type of insurance that covers the cost of long-term care, including nursing home care. It is important to purchase this insurance before you need it, as it can be difficult to obtain once you are already in a nursing home.
• Personal funds: If you have the financial means, you can pay for nursing home care out of pocket.

People Also Ask

What is custodial care?

Custodial care is non-medical care that helps individuals with daily activities such as bathing, dressing, and eating. It is not covered by Medicare.

What is the difference between skilled nursing care and custodial care?

Skilled nursing care is medical care that requires the expertise of a licensed nurse, such as administering medications or providing wound care. Custodial care is non-medical care that helps with daily activities such as bathing, dressing, and eating.

What is the average cost of nursing home care?

The average cost of nursing home care varies depending on the location and level of care required. According to Genworth's 2021 Cost of Care Survey, the national median cost for a semi-private room in a nursing home is $7,756 per month.

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Conclusion

While Medicare does cover skilled nursing facility care under certain conditions, it does not cover custodial care, which is the type of care most nursing home residents require. If you or a loved one needs nursing home care but Medicare does not cover it, there are other options to consider, including Medicaid, long-term care insurance, and personal funds. It's important to plan ahead and explore all of your options to ensure that you or your loved one receives the care they need.