Does Medicare fully cover nursing home care, and are there alternatives?

Question

Sean Davis · Accepted Answer

Medicare does not fully cover nursing home care. It only provides limited coverage for skilled nursing facility care under certain conditions, such as after a qualifying hospital stay of at least three days. Even then, Medicare typically covers only the first 20 days fully, with beneficiaries responsible for a daily copayment for days 21 to 100.

For long-term care in nursing homes, Medicare does not provide coverage. Alternatives for covering these costs include Medicaid for those who qualify based on income and assets, long-term care insurance, or personal savings. It's important to explore different options well in advance to ensure a comprehensive plan for potential long-term care needs.

Larry Dalton · Answer

Traditional Medicare and nursing home coverage provide only short-term coverage. If one needs nursing home care services in the future, it is important to get long-term care insurance.

Christopher Boyd · Answer

In 2025, Medicare Part A is Limited to only 20 days of full Skilled Care and partial co-pay of up to 100 days total, per benefit period, when the senior leaves the inpatient 3-day minimum hospital admission stay. This is limited to Skilled Care Only. Not residential nursing home/long term care stay.

Medicare provides zero Long Term Nursing Home Care funding. Per the 2025 Medicare and You Handbook, there are only TWO Nursing Home coverage options: Medicaid or private Long Term Care Insurance. Further, the Medicare Book recommends seniors plan for their long-term care NOW to ensure they can get the care they want, in the setting they want, in the future. Medicaid Spend Down laws can vary state by state and change each year. 
Long Term Care Insurance policies written in 2025 and beyond can provide coverage at home, adult day care, assisted living, hospice, nursing home care, etc, without having to spend down ones assets and keep help control of their money and indepence.

Tom Rogala · Answer

No.  You need a long term care policy.  The younger and healthier you are the cheaper it will be.  Some go with advantage over medigap and use the saving to fund LTC.

Michael Ryan · Answer

No, Medicare generally doesn't fully cover nursing home care, especially for long-term custodial care, but it may cover some skilled nursing facility (SNF) stays under specific conditions, like following a qualifying hospital stay. 

Here's a more detailed explanation:

Medicare's Coverage:
Medicare Part A can cover skilled nursing facility (SNF) care for a limited time (up to 100 days) if you meet certain conditions, including a qualifying hospital stay of at least three days. 

Custodial Care:
Medicare typically doesn't cover custodial care, which is the type of care that helps with activities of daily living (ADLs) like bathing, dressing, and eating. 

Skilled Nursing Care:
Medicare may cover skilled nursing care in a nursing home, or in your home (with home health care), if you need short-term skilled care for an illness or injury and you meet certain conditions. 

Medicaid:
If you need long-term care and don't qualify for Medicare, you might explore Medicaid, which can help cover long-term care costs in a nursing home. 

Other Options:
Consider long-term care insurance, or explore veterans benefits if applicable.  There are other options available that will assist.  For the most part it entails preplanning not waiting until the services are needed.

Kelsey Hentzen · Answer

The short answer is no, Medicare does not fully cover the costs of nursing home care, particularly long-term care. Medicare generally covers skilled nursing facility (SNF) care for a limited time, primarily for post-hospitalization rehabilitation needs. However, there are options for long-term care and we discuss these options in our office with clients.

Answered by Kelsey Hentzen on April 28, 2025

Broker Licensed in KS & MO

Answered by Kelsey Hentzen Medicare Insurance Agent

Mary Turner · Answer

Medicare covers up to 100 days of custodial care which is rehab for the most part.  Medicare does NOT pay for long term care. 

Options for long term care include Medicaid, self pay, long term care policies, life insurance with a terminal clause rider, etc. 

Which option you choose depends on many factors such as assets, health, and more.

Nathan Curry · Answer

Long-term nursing home care is not fully covered by Medicare, as is commonly believed. Medicare Part A may cover a short stay in a skilled nursing facility, but only under certain conditions, such as following a qualifying hospital stay and requiring skilled care. Even then, the coverage is limited to 100 days. The first 20 days are completely covered, but on day 21, there is a daily copay.

Medicare does not cover long-term custodial care, which includes assistance with daily tasks such as bathing, dressing, and eating. Long-term care insurance, Medicaid (if you qualify financially), hybrid life insurance policies with long-term care benefits, or personal savings and assets are all options for paying for this type of care.

Edward Allen · Answer

Original Medicare Part A Hospital benefits cover up to a maximum of 100 days. 
Alternatives are Medicaid, or a Long Term Care policy. Assisted Living Facilities, Senior Care Apartments

Steven Bleicher · Answer

No, it does not. Medicare only covers the 1st 100 days at a Nursing Home, Assisted Living and Alzheimer's facilities. To be more specific, within the first twenty days, there is no cost at all to you. Then, on days 21 - 100, it reverts to a daily rate which is $204.00 per day. If you've enrolled in a Med. Suppmt., depending upon the "letter" of the Suppmt., that is also fully paid for. But when you've reached the 100th day, Medicare drops out. The Medicare Advantage plan is different from a Suppmt. and each insurance company will vary those and its hospital benefits. If you've previously enrolled into a Long-term care policy, that should kick in on Day 101 and also will be dependent upon what benefits you had opted for within either a LTC or "Recovery Care" policy (which used to be known as Short-term care). Always remember that some states dictate their own regulations with specialty care; I can only generalize the above.

Answered by Steven Bleicher on April 11, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Gregg Matheny · Answer

No it does not. Yes Medicare does help out with care from a skilled nursing facility. Days 1-20 Are covered in full by Medicare. Days 21 through 100 there will be a set co-pay of a little over $200 per day. After day, 100 you are responsible for all costs. Unfortunately Medicare doesn’t cover any type of custodial care or long-term care.

Answered by Gregg Matheny on March 26, 2025

Agent Licensed in AZ & UT

Answered by Gregg Matheny Medicare Insurance Agent

Leslie Helene Sussman · Answer

Medicare covers Medically necessary part-time or intermittent skilled nursing home care services and more (ei Physical and Occupational Therapy).   

There are Long-term care resources and local services available.

Medicare typical covers Hospice care.

In your Medicare and You Handbook 2025 page 43-44.  If you do not have a Medicare and You handbook - I can email you a digital copy.

Diana Garner · Answer

No, Medicare does not fully cover nursing home care. Medicare Part A may cover a short-term stay in a skilled nursing facility (SNF) after a hospital stay, but it does not cover long-term custodial care.

Alternatives to Medicare for paying for nursing home care include Medicaid, long-term care insurance, and private pay. 

Some life insurance policies or even annuity products offer living benefits that are built in to the plan that will help cover SNF expenses.

Harold Randolph · Answer

Medicare doesn’t cover nursing home care. Medicare does cover the first 20 days of skilled nursing care. Afterwards there is a daily copay for being facilitated. There are options to prepare for the inevitability of needing rehab services. 
Reach out to a broker to look at long term care and short term care options while you’re healthy.

Patrick Stinson · Answer

Medicare Part A will pay 100% of the covered costs of care in a skilled nursing facility (SNF) for the first 20 days of a covered stay. For days 21 through 100, Medicare will cover a portion of the costs, and the patient will be responsible for a daily coinsurance. After 100 days, Medicare will no longer cover the cost of the SNF stay. 

Medicaid is a joint federal and state program that helps pay health care costs if you have limited income and (in some cases) resources and meet other requirements. Some people qualify for both Medicare and Medicaid. Most, but not all, nursing homes accept Medicaid payment. Even if you pay out-of-pocket or with long-term care insurance, you may eventually "spend down" your assets while you’re at the nursing home, so it’s good to know if the nursing home you chose will accept Medicaid.