When Does Medicare Pay for a Nursing Home?

Medicare must approve a nursing home before coverage begins.

Medicare pays for temporary skilled care in a nursing home after a hospital stay. Nursing home care must be medically necessary for rehabilitation purposes. Medicare does not pay for long-term nursing home or custodial care.

Eligibility

Medicare pays for nursing home care after a qualifying 3-day hospital stay. You must enter a Medicare-approved nursing facility within 30 days of release from the hospital.

Time Frame

Complete Medicare coverage lasts for the first 20 days of nursing care. A copay of up to $128 applies for days 21 to 100. After 100 days, Medicare coverage ends for skilled nursing care for that benefit period. A new benefits period begins after a 60-day break in nursing home care.

Coverage

During a qualifying nursing home stay, Medicare pays for semiprivate rooms, meals, nursing care, rehabilitation treatments, medical social services, medications, medical supplies, transportation and dietary aid.

Alternatives

Medicaid, a state and federal program, may help with long-term nursing home care for low-income individuals. Some private insurance companies also provide long-term care insurance to help offset costs.

References

• Centers for Medicare and Medicaid Services: Medicare Coverage and Nursing Homes
• District of Columbia, Department of Human Services: Home Care and Nursing Home Services
• Maryland Attorney General: How to Pay for a Nursing Home