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Paying for a Nursing Home When Medicare Ends
Written by Leah Hallstrom
about the author
6 minute readLast updated April 4, 2023
Reviewed by Letha Sgritta McDowellLetha Sgritta McDowell is an attorney practicing in both Virginia and North Carolina. She is a fellow of the American College of Trusts and Estates Council, a certified elder law attorney, and a past president of the National Academy of Elder Law Attorneys.
Seniors often need medical and/or personal care support after hospitalization. Whether they’re recovering from a stroke or rehabilitating after hip replacement surgery, seniors can benefit from skilled nursing care for many reasons. Provided most often in a designated facility or at a nursing home, skilled nursing services are essential for senior care. While Medicare won’t cover long-term nursing home stays, it does cover short-term skilled nursing care for eligible seniors in need of such services. Since Medicare’s coverage is only available for a short time and under very specific circumstances, it’s crucial to understand who’s covered and for how long.
Key Takeaways
- Medicare only covers short-term nursing care. Medicare covers up to 100 days of skilled nursing care for eligible seniors who meet strict requirements.
- There may be out-of-pocket coinsurance due during Medicare’s coverage period. While patients are covered for 100 days, there may be up to $200 a day in coinsurance payments due starting on day 21.
- Seniors have other options to pay for skilled nursing services. Once Medicare coverage ends, consider using personal savings, private insurance plans, or federal and state programs to pay for care. Once Medicare coverage ends, consider using personal savings, private insurance plans, or federal and state programs to pay for care.
- Many seniors will need continuing care after a short-term nursing home stay. If your loved one needs additional support, consider assisted living or memory care communities.
What happens when Medicare stops paying for nursing home care?
Medicare coverage is limited to short-term nursing home stays, and after a certain benefit period ends, seniors will have to pay for their own nursing home care. Many confuse “nursing homes” with “skilled nursing,” further muddying the waters when trying to figure out what’s actually covered by Medicare. Several types of facilities offer skilled nursing services, so seniors and their doctors can work together to find the best fit for their needs. We’ll explore two options — nursing homes and skilled nursing facilities — below.
Understanding nursing home services
Nursing homes most often focus on providing custodial care, which includes help with activities of daily living (ADLs) like eating, bathing, dressing, and toileting. Other common services may include: Though nursing homes are primarily designed to provide personal care services, they do generally have nurses and aides on staff. These professionals may be able to offer some medical services like wound care, medication administration, and injections. More intensive medical care may be provided by external or third-party caregivers. Facilities that don’t have on-site specialists must either bring in professionals or arrange transportation for residents to see their regular doctors.
- Mobility assistance
- Medication management and administration
- Nutrition and dining
- 24-hour supervision and monitoring
- Palliative and hospice care
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Nursing homes generally provide long-term care for residents. So when a senior moves into one of these communities, it’s typically a permanent move. However, it’s also possible for seniors to receive short-term care in a nursing home facility as they recuperate or recover from illness or injury. Medicare only covers medically necessary short-term skilled nursing care , which may be provided in a nursing home setting.
Does Medicare cover nursing home costs?
No, Medicare doesn’t cover long-term nursing home stays. It also doesn’t provide coverage for long-term care in other settings, such as a senior’s home, a memory care facility, or an assisted living community.Understanding skilled nursing care
Skilled nursing services provide patients with expert medical care. Seniors may seek skilled nursing services for rehabilitation or preventative treatment. Care may be provided at a nursing home or a skilled nursing facility (SNF). SNFs typically employ a wide range of medical professionals, including: Because SNFs have experts on-site, they can provide a level of care that many nursing homes can’t. Skilled nursing care often includes: Unlike nursing homes, SNFs generally only provide short-term care. This is because the goal of skilled nursing care is to get seniors back home to their normal lives and regular routines. How much Medicare will cover depends on how long a senior must receive skilled nursing care. For the first 20 days, seniors will pay nothing for care. From days 21 to 100, patients may be required to pay up to $200 in coinsurance fees each day, some or all of which may be covered by a Medicare supplement policy. So what happens when Medicare stops paying for nursing care? Starting on day 101, all costs fall to seniors and their families. If at any point during these 100 days a doctor deems that skilled nursing services are no longer required, Medicare coverage will end. If this is the case, the nursing home or SNF must provide the insured with a Notice of Medicare Non-Coverage form.[02]
- Doctors
- Registered nurses (RNs), licensed practical nurses (LPNs), and licensed vocational nurses (LVNs)
- Physical, occupational, and speech therapists
- Pain and symptom management
- Wound and catheter care
- Injections and IVs
- Personalized therapy treatments
Does Medicare cover skilled nursing services?
Medicare covers skilled nursing services for eligible seniors during a limited benefit period of 100 days. Skilled nursing care will be covered if a senior:- Is enrolled in Medicare Part A
- Has recently (within the last 30 days) received inpatient care at a hospital for three or more consecutive days
- Is given doctor’s orders for medically necessary and reasonable daily skilled nursing services
- Selects a Medicare-certified facility where they plan to receive care [01]
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Ways to pay for long-term care
Once Medicare coverage ends, it’s important to have a plan in place to cover future costs if your loved one requires a longer stay in a nursing home or SNF. From state and federal programs to personal funds, seniors and their families should consider other payment methods to ensure essential care continues.
- Medicaid is available for low-income adults who need help covering medical costs. For eligible seniors, medical care in nursing homes and skilled nursing services are both covered by Medicaid, though each state has its own rules and requirements for coverage.
- VA benefits may be available to eligible veterans or their spouses or dependents who have a demonstrated need for skilled nursing care.
- Private resources like personal savings, retirement accounts, investments, or proceeds from property sales are often used to help fund care.
- Long-term care insurance policies cover several senior living options including assisted living communities and nursing homes. Individual policies may limit what medical conditions are covered, so seniors should work with an insurance broker, agent, or financial advisor to identify what’s covered in their existing policy or inquire about how to apply for one.
Exploring senior care options for continued support
If your loved one has completed their rehabilitation but still requires a high level of medical care, they can remain in a nursing home on a long-term basis. Even though Medicare won’t cover custodial care costs, it may cover specific medical services provided in a nursing home setting. Fortunately, there are additional options to consider if a nursing home is no longer the right fit. And while Medicare won’t cover the costs in full at these communities either, some medical services will likely be covered. Need help exploring the services, amenities, and costs of senior living locations across the country? Reach out to a Senior Care Advisor today to get help navigating senior care options for your loved one.
- Assisted living communities aim to support the physical, social, and emotional well-being of older adults. Seniors can get personalized care including help with instrumental activities of daily living (IADLs) and some ADLs in a comfortable and welcoming environment. While Medicare won’t cover the cost of custodial care or ADL assistance, it may cover medical service costs, including medications, some therapies, and durable medical equipment.
- Memory care communities provide services and housing for seniors with Alzheimer’s disease and other forms of dementia. Staff are specially trained in these conditions and offer person-centered care so residents receive individualized support. Medicare will likely cover tests for cognitive decline, physical and occupational therapy related to dementia, medical supplies, and off-site doctor visits.
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References
Centers for Medicare and Medicaid Services. Skilled nursing facility (SNF) care.
Medicare Initiative. (2023) SNF care past 100 days.
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