Does Medicare Pay For Nursing Homes?

Nate Birt

Written by Nate Birt on Tue Dec 06 2022.

If you are searching for high-quality care for your loved one, you might wonder: Does Medicare pay for nursing homes? In this post, we’ll walk you through some common questions and provide answers and resources to help guide you.

If you are searching for high-quality care for your loved one, you might wonder: Does Medicare pay for nursing homes? Although Medicare is a federal program that does not cover long-term care, there are some exceptions for nursing home-type facilities. Additionally, you might learn that your loved one is eligible for coverage through Medicaid, a different federal program for seniors with limited income. 

In this post, we’ll walk you through some common questions and provide answers and resources to help guide you.

What is Medicare?

Medicare is a federal health insurance program that applies to three groups of people. Your loved one might qualify if they are:

  • 65 years or older

  • Under 65 with specific types of disabilities

  • Experiencing major kidney problems

There are four components of Medicare: parts A, B, C, and D.

  • Part A encompasses different types of coverage for hospital visits. This might include inpatient treatment, skilled nursing support, and certain types of care at home. If your loved one or their spouse worked and paid taxes, they might not have to pay a premium for this type of care. Alternatively, they might be eligible to purchase Part A coverage.

  • Part B covers things like doctor visits, outpatient treatment, medical equipment (like hospital beds or walkers), and preventive services/screening. Most recipients pay some type of premium for Part B. 

  • Part C essentially puts all the Medicare parts into a single bundle. Perks of this part can include smaller out-of-pocket costs compared to only opting for original Medicare. It can also cover other types of treatment not included elsewhere in Medicare. This might consist of benefits for eye care, dental checkups, and hearing.

  • Part D supports seniors with their prescription drug costs. Private companies run this according to Medicare rules. It makes drugs more affordable and might help avoid some future price increases.

In some cases, Medicare won’t cover all medical costs. In those cases, you might need to purchase a Medicare Supplement Insurance policy from a company. Sometimes, this is referred to as Medigap coverage.

Are nursing homes included in Medicare coverage? Why or why not? 

So does Medicare pay for nursing homes? In general, nursing homes aren’t covered by Medicare. This is because Medicare is designed to provide other types of coverage. For example, Medicare provides health insurance for specific kinds of hospital expenses. It also provides general health care coverage and support for medical equipment such as wheelchairs. 

In some cases, your loved one might be eligible for Medicaid. This special type of federal program for low-income Americans does allow for some coverage of long-term care, which might include a nursing home. It’s important to visit with experts to understand the options available to you. There is a Medicare hotline at 1-800-MEDICARE where you can ask questions and learn about the possibilities for your loved one. Alternatively, you can log onto the Medicare website and start a live chat with an expert.

What are alternative ways to pay for nursing homes if Medicare does not pay? 

There are several other ways to cover nursing home expenses. Some of those options include:

  • Life insurance: Some policies let you use a portion of your loved one’s funds for nursing home costs. Revisit policies in place and call the insurer if you have additional questions.

  • Long-term care insurance: If your loved one has long-term care insurance, it may cover nursing home care. Review policy statements online or documents sent via the mail. You can also call the insurance company for further details. Some policies might limit the available coverage because of a preexisting condition. A conversation over the phone should answer many of these questions. 

  • Program of All-Inclusive Care for the Elderly (PACE): In select states, the PACE program can use Medicare coverage to provide nursing home-equivalent services, frequently at home. This can help patients with Alzheimer’s and related conditions.

  • Personal savings: Some seniors have personal savings their caregivers might use to fund some or all nursing home expenses. Because Medicare is limited in its ability to cover these costs, savings set aside over the years can significantly benefit your loved one. 

Where can I learn more about what Medicare does and does not cover?

A helpful overview document on Medicare and Medicaid is available on the Medicare website. 

You can also visit Medicare.gov to check out informational resources, enrollment deadlines, and details on providers in your loved one’s community.

What is Medicaid?

This program operates with help from both federal and state governments. It’s intended to help low-income Americans access essential benefits, one of which can be care at a nursing home. Each state has different rules for Medicaid eligibility. You’ll need to do a little homework to understand the requirements of the state where your loved one lives and whether they are eligible. To do this, visit the state Medicaid eligibility map on the Medicaid.gov website.

Who qualifies for nursing home coverage through Medicaid?

As mentioned, each state has different guidelines for the level of income or assets your loved one can have to qualify for nursing home coverage through Medicaid. This typically includes a review of your loved one’s monthly income level. 

The decision to seek nursing home care is personal and can greatly benefit your loved one if they require a level of care you can’t provide. Although Medicare doesn’t typically cover nursing home care, other options are available to ensure your loved one receives the help they need.

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Nate Birt
Nate Birt

Nate Birt is the founder of Silver Maple Strategies, a consulting company that provides premium encouragement and communications solutions to help social purpose leaders make a lasting impact in harmony with their personal values. A University of Missouri journalism graduate, author and public speaker, Nate and his wife, Julie, live with their four children on a small farm in northeastern Missouri.