When Does Medicare Pay for Nursing Home Care?

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Claire Smith 05-05-2021

How to Finance Nursing Home Care?

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Because nursing homes offer around-the-clock care from professionals, there is no way to escape the expense. In 2019, nursing homes cost around $100,000 per year. This number is kind of daunting and you may be wondering “How will I be able to pay for nursing home care?”

Well, when it comes to nursing home care, there are a variety of different plans and benefits available, even within Medicare. Because of this variety, whether or not Medicare will cover nursing homes depends on multiple factors.

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Does Medicare Pay for Nursing Home Care?

Generally speaking, Medicare will not pay for nursing home care. There are, however, a few special circumstances in which Medicare will cover nursing homes.

As you may already know, Medicare offers four different plans: A, B, C, and D. Plan A covers hospital stays. Plan B covers outpatient care. Plan C (also known as an Advantage Plan) is a bundled plan administered by private companies, meaning that coverage will differ. And Plan D covers prescription drugs. 

When Does Medicare Cover Nursing Home Care?

Medicare Plan A will cover up to 100 days of nursing home care in specific circumstances. If you are sent to a hospital for over three days as an inpatient (meaning you were not under observation), and then a doctor sends you to a nursing home for recovery, then Plan A will cover skilled nursing care.

Skilled nursing care does not include services like assistance while bathing or using the bathroom. Those types of everyday care are called custodial care and are not covered. After 20 days in the nursing home, Plan A will require you to pay a $176 coinsurance per day. After 100 days, you will be responsible for the full cost of your nursing homestay.

Medicare Plan B generally does not provide funding for nursing homes as it is primarily focused on outpatient care such as doctor’s appointments, seeing the chiropractor, etc.

Medicare Plan C can cover nursing home stays, depending on your provider and the extent of coverage that you opt for. Some Medicare Advantage Plan providers have deals with certain nursing homes to provide their clients with nursing home coverage. Be in touch with your provider so you know exactly what is covered.

Medicare Plan D will be able to cover or partially cover the cost of prescription drugs that you are dispensed with while in a nursing home. But no skilled or custodial services will be covered.

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What Happens When Medicare Stops Paying for Nursing Home Care?

You might be getting stressed about how you will cover the cost of nursing home care while reading this article. But Medicare is not the only option to finance a stay at a long-term care facility.

Hospice benefits are for those who are in need of palliative care. If a doctor certifies that a patient has less than six months to live, the patient may qualify for a hospice benefit that covers the cost of palliative care.

If you are not in need of palliative care, but in need of long-term care there are four basic payment options outside of Medicare:

  1. Private Pay: Many people pay out of pocket for nursing home care through their savings or tapping assets.
  2. Long-Term Care Insurance: This is a separate insurance policy that is specifically designed for nursing home care. Read all the terms on your policy to understand the extent of your coverage.
  3. Medicaid: Those with limited resources may qualify for Medicaid which can cover long-term care expenses.
  4. Veterans Administration: The U.S. Department of Veterans Affairs offers nursing home coverage to Military veterans.

It can be tough to try to figure out how to finance nursing home care. But for some individuals, such long term care is necessary. With a little bit of research, you will be able to find the best way to obtain nursing home coverage. 

Claire SmithClaire is a creative entrepreneur with a variety of marketing and content creation skills, including blog and web copy writing, research, and strategy. She has a Masters in Cultural Studies from Queen's University and is known for thinking laterally about marketing, based on her deep knowledge of people and behavior.