Will Medicare cover my nursing home costs?

Will Medicare cover my nu…

Many times when I meet with families who have a loved one who was just admitted to a long term care facility, one of the first questions they have is whether Medicare will cover the costs incurred. They understand that the costs of the long term care facility will be significant, and they are hoping for good news about Medicare's coverage.

Unfortunately, the news is not very good. While Medicare does cover skilled nursing care in a long term care facility for a limited time, Medicare doesn't cover the majority of the long term costs. Let's take a look and see how the coverage is calculated.

Medicare Part A (hospital insurance) covers skilled nursing care, whether in a hospital or in a long term care facility. However, most of the care in a long term care facility is not skilled nursing care and is considered “custodial care.” While this is not always the case, the cost that Medicare will pay for a stay in a long term care facility are as follows:

  • Days 1 - 20: Medicare pays 100%
  • Days 21 - 100: Medicare pays a portion of the cost (you are responsible for a daily co-insurance payment - $185.50 per day in 2021)
  • Days 101 and beyond: Medicare pays nothing.

Of course, when a person is in a long term care facility, they still receive medical care from doctors and nurses, medications, and other such services. Medicare continues to pay those costs, but the cost of the custodial care is not covered beyond day 100.

To learn more about your options for paying for long term care costs, read Paying for Long Term Care. If you need help with planning for a long term care stay for yourself or a loved one, click this link and request a no-cost initial appointment with attorney Tim Alley.