Nursing Home Medicare Coverage

Medicare coverage of nursing home care is a complex subject, so it can be confusing to understand how the program works. In this article, we’ll outline who qualifies for Medicare coverage of nursing home care and what that coverage entails. We’ll also explain how much Medicare will pay for certain services provided in nursing homes and other settings.

Who qualifies?

• You must be eligible for Medicaid to qualify.
• You may not qualify if you are eligible for both Medicare and Medicaid, or have insurance that covers nursing home care outside of a facility.

What’s covered?

Medicare Part A covers the following:

• Nursing home care and skilled nursing care
• Physical, speech, and occupational therapy
• Podiatry (foot care)
• Dental services (dentures, bridges, root canals)
• Rehabilitative services (physical therapy, occupational therapy)
• Home health care services

Some other types of medical supplies that may be covered include:

How much will it cost?

The cost of nursing home care is one of the most important factors to consider when making your decision. The cost of a private room can range from $90,000 to $150,000 annually and up, depending on the state you live in and facility you choose.

The price also depends on whether or not you have other health insurance coverage. If you are receiving Medicaid benefits for nursing home care, then your costs will be substantially reduced—although even so it may still seem like an insurmountable sum for some people at first glance.

Medicare covers some nursing home care, but not all of it.

Medicare covers skilled nursing care, but not custodial care. Medicare will cover some of your stay, but only for the days that you need skilled care.

For example, if you have a broken leg and need to stay in the hospital for several weeks while it heals and then another month in a rehabilitation facility, Medicare will cover those medical costs. However, if you’re recovering from a stroke that left you unable to feed yourself or walk unassisted and must spend months at home before being able to return to independent living, Medicare won’t pay anything toward your cost of living at home.

Medicare is a government-run program that provides health care coverage for Medicare beneficiaries. You qualify for the program if you’re 65 or older or permanently disabled. If you do qualify, Medicare will cover some of your costs while you’re in a nursing home. However, there are limits on what it will pay and certain conditions must be met before coverage begins.