Does Medicare Cover Nursing Homes?

Medicare does not cover custodial care in a nursing home, but Medicare Part A may cover care in a certified skilled nursing facility if it is considered medically necessary by a doctor.

Medicare does not cover long-term care or custodial care (such as help getting dressed or bathing), if that is the only care you need.

Woman in a garden

Medicare Part A covers some skilled nursing facility care

Skilled nursing care is a high level of medical care that is provided by trained individuals such as registered nurses, physical and occupational therapists, speech-language pathologists and audiologists.

Examples of services that Medicare may cover in a skilled nursing facility include:1

  • Meals
  • Semi-private room
  • Medications
  • Dietary counseling
  • Medical supplies and equipment used in the facility
  • Physical or occupational therapy that is necessary to meet your health goal
  • Speech-language pathology and therapy that is necessary to meet your health goal

Who qualifies for Medicare coverage in a skilled nursing facility?

Medicare may cover certain skilled nursing facility care if you are enrolled in Medicare Part A (hospital insurance) and you were treated during an inpatient hospital stay that lasted at least three days.

Medicare will cover your skilled nursing facility care if you also meet the following conditions:

  • You have days left in your benefit period to use
  • You receive care at Medicare-certified facility
  • Your doctor determines that care from skilled nursing facility staff is medically necessary
  • The skilled nursing care you receive address a medical condition that was treated during your qualifying three-day inpatient stay in a hospital

Note: you must enter the skilled nursing facility within a short period of time of leaving the hospital (usually 30 days).

Do Medicare Advantage plans cover nursing homes?

Medicare Advantage plans (also called Medicare Part C) provide the same hospital and medical benefits as Original Medicare (Medicare Part A and Part B).

This means that if Medicare Part A will cover your skilled nursing facility care, so will a Medicare Advantage plan.

In addition to the benefits covered by Original Medicare, many Medicare Advantage plans may also offer additional benefits not covered by Original Medicare, such as vision, dental and hearing coverage.

Many Medicare Advantage plans may also offer prescription drug coverage.

To compare Medicare Advantage plans that may be available in your area and to find out if they can help offer some Medicare nursing home coverage, call a licensed insurance agent at TTY Users: 711 24 hours a day, 7 days a week.

 

Learn more about what Medicare covers

 

1 Medicare.gov. (Jan. 2015). Medicare Coverage of Skilled Nursing Facility Care. Retrieved from https://www.medicare.gov/Pubs/pdf/10153.pdf.

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