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Does Medicare Cover Nursing Home Care?

medicare pay for nursing home with medicaid coverage

Medicare covers part-time, non-custodial services in a nursing home or an array of services in a skilled nursing facility. Do not count on Medicare’s help for long term care services.

Medicare Nursing Home Coverage

Medicare Part A covers skilled nursing care in a nursing home or certified skilled nursing facility. That means medically necessary care, such as for changing sterile dressings. 

Medicare does not cover custodial care when it is all the care you need. Custodial care is what a lot of the care you receive in nursing homes tends to be.

What Is Custodial Care?

Custodial care is help with the activities of daily living (ADLs). That includes assistance with the things that an adult needs to function every day, such as bathing, using the restroom, feeding yourself, and getting dressed. Some nursing homes also help with the instrumental activities of daily living (IADLs), which can include help managing finances, preparing meals, and more. Those are sometimes referred to as homemaker services, and are also not covered.

Is All Nursing Home Care Custodial?

medicare coverage and prescription drug coverage at skilled nursing facilities and nursing homesNo, but most of it is. The majority of your time spent long-term in a nursing home is food and bed service, helping you achieve the basic necessities of life. Other care received in a nursing home is called skilled nursing facility care.

Skilled Nursing Facility Care

Medicare does cover care in a skilled nursing facility (SNF). Medicare Part A handles this coverage when you are within your benefit period, you have a qualifying hospital stay, your doctors decide you need daily skilled nursing care, you get the services in a certified skilled nursing facility, and you get the services for a hospital-related medical condition that was treated during your qualifying three-day hospital stay or a condition that started while you were being treated in the skilled nursing facility for a hospital-related condition.

In a skilled nursing facility, you can receive coverage for a semi-private room, meals, skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services, medications, medical supplies, ambulance transportation, dietary counseling, and swing bed services.

Skilled Nursing Facility Care Costs

Under Original Medicare, you would have to pay your deductible of $1,600 for the benefit period, followed by a daily coinsurance of $196 for each day from day 20 through 100 in the skilled nursing facility.

Paying for Nursing Home Care

medicaid and medigap coverage - medicaid eligibility & medicare advantage hospital insurance

Nursing home care can be expensive. A private room in Idaho for permanent residents costs around $9,000 each month, with a cost of around $8,000 for a semi-private room.

One way to prepare for the costs of nursing home care is to get long term care insurance. Long term care insurance provides a daily benefit to use toward the costs of long term care services, such as a stay in a semi-private room in a nursing home. If you need the assistance of full-time daily providers but don’t have the medically necessary conditions warranting skilled nursing attendants, you would be receiving long term custodial care. 

You may be able to save money if a family member or loved one could serve as an in-home caretaker instead of spending your days in a nursing home. There are many affordable options for assisted living, including adult day care services. These health care providers are there to assist you and genuinely care for your progress and fulfillment in life.

For more information about nursing home care or Medicare coverage, contact Teton Medicare.

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