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Does Medicare Cover a Long-Term Stay in a Nursing Home?

16 February 2021

Sherri Ramos

Many people assume that Medicare will cover an extended stay in a nursing home. Unfortunately, this is an incorrect assumption that leads to people being taken by surprise when they find out that they'll need to pay out-of-pocket for long-term care. Relying on your Medicare coverage for nursing home care is financially risky, as it only covers certain types of care in a limited time period. To learn more about what Medicare covers and how you can protect yourself financially if you ever need long-term care in a nursing home, read on.

Does Medicare Pay for Nursing Home Care?

Medicare Part A only covers care at a skilled nursing facility, and the coverage doesn't last very long. The entire portion of your stay at the nursing home will be covered for the first 20 days. For the next 80 days, you spend at the nursing home, you'll need to pay a substantial co-pay for each night you spend there. After those 80 days are up, you'll be responsible for the full cost of your stay.

This model is designed to cover people who are rehabilitating after an injury or illness, rather than people who need assistance with the tasks of daily living. If you have a stroke and need a few weeks of physical therapy in a nursing home afterward, for example, then your Medicare coverage will help make your care affordable.

Unfortunately, Medicare alone isn't suitable for people who need long-term care in a nursing home because they can no longer live safely on their own. Specifically, it only covers medical care in a skilled nursing facility. This is provided by trained professionals such as registered nurses and physical therapists.

Because Medicare doesn't provide coverage for custodial care, it's important to find additional coverage if you think that you may need long-term care in a nursing home.

What Coverage Options Are Available for Nursing Home Care?

One way to protect your assets while also receiving coverage for a long-term nursing home stay is to enroll in a Medicare Advantage plan that offers long-term care coverage. These plans are offered by private insurers, and they provide additional benefits compared to traditional Medicare. Some of these plans offer coverage for long-term care, which means that they'll pay for an extended nursing home stay.

You also have to option of enrolling in long-term care insurance, which is specifically designed to cover extended stays in a nursing home. You pay a monthly premium to the insurer, and in return, they'll pay for the majority of your nursing home stay if you need one.

The downside of these plans is that it can be difficult to secure coverage if you're already a senior or if you have preexisting health problems. Like all insurance companies, long-term care insurers are wary of insuring clients that may be a financial risk to the company. If you're already eligible for Medicare or have health issues, finding a Medicare Advantage plan that offers long-term care benefits will typically be the better option.

You can learn more about your options by contacting Medicare services. 

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