Will Medicare pay for a stay at a nursing home?

Whether Medicare will pay for a nursing home stay depends on the type of nursing home and the services needed by the patient. Medicare limits coverage for nursing home care and long-term in-house nursing to skilled nursing facilities. In order for a stay to be covered by Medicare, the patient must require skilled nursing care (as per doctor's orders), and the nursing home must be certified as a Medicare "skilled nursing facility provider." Medicare Part A can also help pay for certain inpatient care in a Medicare certified skilled nursing facility following a hospital stay of at least three days in a row, not counting the day of discharge. 

Skilled Nursing Facilities and Medicare

If your primary purpose for entering a nursing home is for custodial care, rather than skilled nursing services, then Medicare will not pay for the stay. "Custodial care" is assistance with daily living. Activities which are considered "daily living assistance" include walking, dressing, and eating. Generally, these services may be recommended by a doctor, but are not part of a doctor’s orders for a person’s medical care plan.

If a stay at a nursing home is not covered by Medicare, a senior citizen or disabled person may still qualify for help for payment of nursing home expenses through other sources. For instance, Medicaid will help pay nursing home expenses for low income or disabled individuals. Medicaid income guidelines can vary across states, and will generally depend on a person’s income, their assets, and their marital status.

Other Funding Options for Nursing Home Stays

In addition to Medicaid, a senior citizen or disabled person may review private sources as well, including establishing trusts, purchasing gap insurance, filing a claim on long-term disability plans, or retirement funds. To the extent possible, proactively planning for retirement needs by setting up and funding retirement accounts or trusts is the ideal solution for paying for a nursing home. Even though Medicare limits its payment options, several other options may be available before you make any final decisions regarding nursing home care. Consulting with an attorney who regularly handles Medicare or Medicaid claims can reduce many of the frustrations of dealing with these government programs' red tape.