How Long does Medicare Pay for a Nursing Home?

Nursing home care falls into two categories:

  • Patient care that requires skilled nursing care.
  • Patient care that does not require skilled nursing care and consists only of custodial care.

What Medicare Pays for Skilled Nursing Care?

Original Medicare Part A pays 100% for the first 20 days in a skilled nursing facility as long as the patient has spent three nights in the hospital, the care is medically necessary and they need daily skilled care. After the first 20 days the patient will pay $141.50 a day in co-pay for days 21-100 for each care period. After that time the patient pays for 100% of care unless they have a Medigap policy. Skilled nursing care that is covered by Medicare includes: semi-private room, meals, nursing care, rehabilitation services, intravenous fluids and pain medications.

If a patient with Original Medicare also has a Medigap policy skilled nursing care and other services are covered for a longer period of time and patient out of pocket costs are significantly less. Medigap Plans are all slightly different with some plans paying for more patient costs than others. The standard core benefit is that the Medigap Plans pay the $141.50 co-pay for skilled nursing care for days 21-100.

Medicare only pays for skilled nursing and will not pay for custodial care. In practice this means that as long as a patient needs daily skilled nursing care they will receive daily custodial care. However, when skilled care is no longer needed on a daily basis Medicare will not cover any of the bills related to custodial care.

Original Medicare Part A will pay for some custodial care received at home for "homebound patients." Homebound patients are those for whom leaving the house takes an "extreme" effort. A doctor must order homebound status and the care received. Then Medicare will pay for things like physical/occupational therapy and in-home skilled nursing care. Original Medicare doesn't provide long-term care or basic custodial nursing home care of any sort.

Medicare was designed to provide short-term nursing home coverage rather than old age care and management. Medicare is available to help you cope with large medical bills but it is not there to take care of you when you get old. In addition, Part A does not pay for doctor's visits, durable medical equipment (including canes, walkers and wheelchairs), prescription drugs or any type or long-term pain management. Coverage for these things is only available if a patient is also signed up for Original Medicare Part B and Part D or they have a Medicare Advantage Plan that includes all of these types of coverage.