How Long Does Medicare Pay For Nursing Home Care?
After an accident or illness, you may need care from a skilled medical provider. In some cases, this care can be delivered at home. Other times, you may need to stay in a facility during your recovery.
A Medicare-certified skilled nursing facility (SNF) can provide dedicated care during your recovery. While Medicare often covers SNF care, it has specific rules about what's covered and how long coverage lasts.
How does a skilled nursing facility differ from a nursing home?
Skilled nursing facilities provide short-term medical care while you recover from an illness or injury. At an SNF, you'll receive 24/7 nursing care, help managing medications, and specialized therapies. The staff can also assist with activities of daily living (ADLs) like dressing, walking, and eating.
Unlike nursing homes, SNFs focus on helping you rehabilitate and return home through specialized care services. Some facilities offer skilled nursing care and rehabilitation as well as long-term custodial care, managing ADLs.
How many days does Medicare cover in a skilled nursing facility?
Medicare Part A covers up to 100 days of SNF care per benefit period:
First 20 days: A semi-private room is fully covered by Original Medicare.
Days 21-100: You’ll owe a daily coinsurance amount of $209.50 per day (Note: this figure changes annually). If you have a Medicare Supplement (Medigap) plan, your Medigap policy may pay the coinsurance amount.
Day 101 onwards: You pay all costs.
To qualify for SNF coverage, you must have a prior hospital stay of at least three consecutive days, not counting the day of discharge. You also must enter the SNF within the first 30 days of hospital discharge. Some Medicare Advantage plans may waive these requirements, but this is not universal across all Advantage plans.
Medicare benefit periods start when you're admitted as an inpatient to a hospital or SNF. Each benefit period ends after you go 60 days without inpatient care. While there's no limit to how many benefit periods you can have in your lifetime, each new period requires another qualifying hospital stay.
Medicare Part B covers additional services, like doctor visits, while in an SNF.
Your options after Medicare SNF coverage ends
Once you’ve received 100 days of skilled nursing care in a benefit period, you'll need to plan for your next steps. If you still need care after your Medicare coverage ends for the benefit period, there are several options:
Medicare will still cover medically necessary services like doctor visits and medical supplies, even after the SNF coverage ends.
You can receive therapy services at home through Medicare-covered home health care, including physical therapy, occupational therapy, and speech therapy.
You can arrange for custodial care through a family member or paid caregiver who can help with daily activities.
You can transition to assisted living, though you'll need to pay these costs yourself or through long-term care insurance.
You can explore Medicaid coverage for nursing home stays in a long-term care facility. (Note: you’d need to qualify based on your financial situation.)
Before you leave the SNF, the facility's social services staff should meet with you to discuss your care needs and help connect you with the services that best fit your situation.
Does Medicare cover long-term care in nursing homes?
No, Medicare does not cover long-term nursing home costs. Though it may pay for additional periods of short-term coverage if you need a hospital visit and another stay in an SNF.
Assisted living as a post-SNF option
Assisted living facilities provide a middle ground between independent living and nursing homes. Staff help residents with activities of daily living (ADLs) and provide custodial care while encouraging independence.
However, the cost of assisted living is a challenge for many. With an average cost of $5,900 per month, assisted living is out of reach for many people who rely primarily on Social Security benefits for income.
While Medicaid won't cover room and board in assisted living facilities, some states may offer waiver programs that help pay for personal care. These programs can provide support whether you live in an assisted living facility or remain in your own home.
How the costs for nursing home care tend to be covered
While long-term care insurance can help cover nursing home costs, few people have this coverage. Premiums also vary widely based on your age and desired coverage level.
The largest source of nursing home payments is Medicaid, which covers 45-65% of all nursing home costs. While it's the biggest source of nursing home coverage, not everyone will qualify for Medicaid.
Beneficiaries or their families also cover a large portion of payments out of pocket. Although Medicare covers some short-term costs (as explained above), it’s not designed to fund long-term nursing home care.
Options to cover home health care costs
Most long-term care at home comes from family members, primarily adult children and spouses, with additional help from other relatives and non-relative caregivers. Beyond familial support, people use Medicaid, personal savings, and private insurance to pay for home health care costs.
Medicare can help ease the burden on family caregivers by covering certain medically necessary home healthcare services. If you qualify, Medicare Part A and Part B cover skilled nursing care, physical therapy, and occupational therapy in your home. Medicare does not cover 24-hour care, meals, or custodial services that provide assistance with ADLs.
Medicaid may cover home health care. But eligibility requirements vary by state and depend on income and asset levels.
Speak to an expert
Have more questions about what Medicare does and doesn’t cover when it comes to nursing home and home health care? Speak with one of our independent Medicare Advisors, who are eager to help you understand your coverage and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.