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Does Medicare Cover Nursing Home Care?

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Medicare is a health insurance program that covers certain health expenses such as skilled nursing facility care, hospice care, preventive screenings, and other healthcare services, but many people wonder if they will get coverage for nursing home care under Medicare. 

In this article, we’ll explain what Medicare covers and whether you can get coverage for nursing home care or not.

Does Medicare Cover Nursing Home Care?

Medicare Part A covers short-term stays in a nursing home that requires skilled care. However, for long-term stays, Medicare plans do not cover the cost.

Medicare does not provide coverage if the beneficiary only needs custodial care at a nursing home. Custodial care services include bathing, dressing, using the bathroom, and eating. In other words, Medicare does not provide coverage for unskilled care in a nursing facility. 

There are certain services Medicare covers in a nursing home facility, but you must meet the specified requirements. First, you must be enrolled in Medicare Part A and must have days left in your benefit period. You must also have had a qualifying hospital stay, and a doctor must have determined that you need daily, skilled care in a nursing home. You must also receive nursing home care in a Medicare-approved facility. 

If you need to receive skilled care while at home, do keep in mind that Medicare will provide a minimal amount of coverage for this service, but this would technically fall into a home health care situation rather than nursing home care. Nonetheless, you will receive coverage for skilled care at a nursing home and home health care as long as the care is medically necessary and is not meant to be long-term.

Other Coverage Options

Medicare Advantage plans usually do not cover nursing home services that are under custodial care. However, some Medicare Advantage plans may have a special agreement with a nursing home to cover certain services. You will need to check with your plan to figure out if this is true for your plan or not.

If it is not, there are other health plans that may be suitable. 

Long-term care insurance covers many nursing home care expenses. Also, Medicaid can help to cover costs for low-income individuals. The VA also provides coverage for certain long-term care services. 

For more information about nursing home care and what your Medicare plan may or may not cover, give the Medicare Gurus a call today!

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