Does medicare pay for skilled nursing care

En español | No, Medicare does not cover any type of long-term care, whether in nursing homes, assisted living communities or your own home.

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Does Medicare cover short-term stays for skilled nursing?
What skilled nursing facility costs does Medicare cover?
How much do I pay if I’m in a skilled nursing facility?

Medicare does cover medical services in these settings. But it does not pay for a stay in a long-term care center or the cost of custodial care — help with the activities of daily living, such as bathing, dressing, eating and using the bathroom — if that is the only care you need.

Does Medicare cover short-term stays for skilled nursing?

Yes, Medicare Part A, which covers inpatient hospital services, will pay for short-term stays in a Medicare-certified skilled nursing facility (SNF) in some situations. Your doctor may send you to there to receive specialized nursing care and rehabilitation after a hospital stay.

Care in a skilled nursing facility is covered only if you had a qualifying hospital stay, meaning that you were formally admitted as an inpatient to the hospital for at least three consecutive days. This is different from observation status, which doesn’t count even if you stayed in the hospital overnight.

When you enter the hospital, ask if you are being officially admitted or if you are there only for observation. That will be important in determining the beginning of your benefit period, which begins the day you are admitted to a hospital as an inpatient or become a patient in a skilled nursing facility , and ends when you’ve been out of those places for 60 days in a row. These rules also mean you might have more than one benefit period in a year.

You must be admitted to a skilled nursing facility within 30 days of leaving the hospital for the same illness or a condition related to it. Your doctor also must certify that you need daily skilled care from, or under the supervision of, skilled nursing or therapy staff.

What skilled nursing facility costs does Medicare cover?

Medicare can cover many of the services you receive in a skilled nursing facility, such as:

A semiprivate room and meals

Skilled nursing care

Medical social services and dietary counseling

Medications, medical equipment and supplies used in the facility

Occupational therapy, physical therapy or speech and language pathology services if needed to meet your health goal

Ambulance transportation if needed to receive necessary services that aren’t available in the facility

How much do I pay if I’m in a skilled nursing facility?

The portion of the costs that you pay depends on the duration of your eligible stay in a skilled nursing facility. You’ll have the following copayments for each benefit period:

$0 for days 1 to 20

$194.50 a day in 2022 for days 21 to 100

All costs day s 10 1 and beyond

A Medicare supplemental policy, better known as Medigap; retiree coverage; or other insurance may cover the copay for days 21 to 100 or add more coverage.

Keep in mind

Medicare doesn’t pay for the considerable cost of long-term care in a nursing home or other facility. But you may have other options to help cover long-term care costs.

Private pay. Many individuals and families pay out of pocket or tap assets such as property or investments to pay for long-term care. If they use up those resources, Medicaid may become an option.

Long-term care insurance. Some people buy long-term care insurance that may pay for custodial care in a nursing home or assisted living facility or for a caregiver to come to their home. To qualify for payouts, you generally must need help with at least two activities of daily living (ADLs) or provide evidence of cognitive impairment.

Veterans benefits. Military veterans may have access to long-term care benefits from the U.S. Department of Veterans Affairs (VA).

Medicaid. The federally financed but state-run health program that provides coverage to people with low incomes pays a considerable portion of America’s nursing home bills. Medicaid eligibility varies by state but requires strictly limited income and financial assets.

Updated July 19, 2022

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Medicare covers up to 100 days of care in a skilled nursing facility (SNF) each benefit period. If you need more than 100 days of SNF care in a benefit period, you will need to pay out of pocket. If your care is ending because you are running out of days, the facility is not required to provide written notice. It is important that you or a caregiver keep track of how many days you have spent in the SNF to avoid unexpected costs after Medicare coverage ends.

Remember that you can again become eligible for Medicare coverage of your SNF care, once you have been out of a hospital or SNF for 60 days in a row. You will then be eligible for a new benefit period, including 100 new days of SNF care, after a three-day qualifying inpatient stay.

If you are receiving medically necessary physical, occupational, or speech therapy, Medicare may continue to cover those skilled therapy services even when you have used up your SNF days in a benefit period—but Medicare will not pay for your room and board, meaning you may face high costs. Check with your provider to see if you qualify for therapy at home through Medicare’s home health benefit, or if you could safely receive therapy as an outpatient while living at home.

If you have long-term care insurance, it may cover your SNF stay after your Medicare coverage ends. Check with your plan for more information. If your income is low, you may be eligible for Medicaid to cover your care. To find out if you meet eligibility requirements in your state, contact your local Medicaid office.