Does Medicare Cover Nursing Homes?

Learn if Medicare covers Skilled Nursing and Long Term Care Facilities

by Katie Banks+ on Jun 27, 2015 | 4 Comments

A nursing home can be defined as a Long Term Care Facility or a Skilled Nursing Facility. These types of round the clock care are covered differently and have completely different expenses, that can be hard be hard to gauge if you don’t know how they are covered. The biggest question is: does Medicare cover either one of them?

Does Medicare Cover Nursing Homes?

We have to break this down into two categories:

Does Medicare cover Skilled Nursing Facilities?
Yes, Medicare offers coverage for care in a Skilled Nursing Facility (SNF) for a limited amount of time AND if you have a 3 day in-patient qualifying hospital stay. This is what you’ll pay for days in a SNF.

  • Part A Deductible: $1,364
  • Days 1-20: $0
  • Days 21-100: $167.50 per day

Does Medicare cover Long Term Care Facilities?
No, Medicare does not cover care in a Long Term Care Facility. Certain companies offer insurance for this type of care, but know that it can be rather inexpensive, so it’s better to enroll in a plan the younger you are.

Does Medigap Cover Nursing Homes?

Medigap plans can cover your Skilled Nursing Facility (SNF) coinsurance and hospital deductible, as long as you meet the 3-day qualifying hospital stay; however, they do NOT cover Long Term Care. This is what is covered with Medigap policies:

  • All but one Medigap plan covers all or part of your Part A Deductible: $1,364
  • All but two Medigap plans cover all or part of your SNF days 21-100 coinsurance: $167.50 per day

If you have a Medigap plan that covers both your deductible and coinsurance you should not pay anything out of pocket for these services.

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Nursing Homes?

Medicare Advantage plans partially cover Skilled Nursing facility care but leave you with a daily coinsurance, and, possibly, a hospital deductible. Good news with Medicare Advantage is some plans don’t require a 3-day inpatient qualifying stay. Medicare Advantage does not cover Long Term Care.

Remember Medicare Advantage plans are not standardized, so you will have to research all plans to learn what your SNF coinsurance and deductible would be.

Learn More about Medicare AdvantageGet a MA Quote

For further questions please call to speak to a Senior65 agent at 800-930-7956.

 

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Reader Comments and Questions

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By Lori on November 07, 2018

I need to inquire into Medicare Advantage and specifically it’s coverage if long term care facilities and prescription drugs. We would probably be most interested in a PPO or PFFF. I need help - this is a lot of info to review.

Lori,
We totally agree that this is a lot to review. Since each Medicare Advantage plan can offer slightly different benefits, you would need to contact our licensed agents to discuss what is covered and help you pick a plan.

Please contact us at 800-930-7956. We would be glad to help you.

-Eric from Senior65.com


By Roger S. on July 16, 2015

Do Skilled Nursing Facility Medicare costs go up every year? It seems really expensive if you don't have Medigap, but I can't really afford to add another premium. And, if the costs skyrocket I won't be able to afford it at all. What are your thoughts?

Roger,
Good question. Skilled Nursing Facility costs, as well as, most Medicare costs go up each year, but usually the increase is not drastic. If you can't afford Medigap, which is understandable, you might want to consider Medicare Advantage because it puts a cap on your out of pocket spending (Original Medicare does not have a cap). Hope this helps.
-Chris from https://www.senior65.com/


By Yennie on July 02, 2015

Does medigap or med adv cover more for skilled nursing?

Yennie,
That's a great question. And it depends. If you have a Medigap plan that covers your Part A deductible and SNF coinsurance/copays, then it would be the better option. If you don't, some Medicare Advantage plans have lower Skilled Nursing Facility coinsurance/copays than Original Medicare. Hope this helps.
-Eric from https://www.senior65.com/


By Bobby on June 30, 2015

So none of the above cover long term care? Am I missing something?

Bobby,
We wish you were missing something, but you've got it! Medicare, Medigap, and Medicare Advantage, as of now, do not cover Long Term Care. You would need to enroll in a stand-alone Long Term Care insurance plan if you wanted this type of coverage.
-Chris from https://www.senior65.com/



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