Does Medicare cover nursing homes?

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Dear Connie,

My mother’s health is deteriorating, and I’m looking into long-term care options. I’m confused. What is the difference between assisted living and nursing homes?

My mother has a Medicare Advantage plan, and I’m wondering, does Medicare cover nursing homes?

Confused by Medicare coverage,
Jennifer from Evanston, Illinois

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Dear Jennifer,

Researching the proper care for a family member can be a difficult task. And we know that Medicare can be confusing. We’re here to support you throughout your journey.

You have great questions. And there needs to be more clarity about the difference between assisted living and nursing homes. I’ll do my best to review the differences and answer your question about whether Medicare covers nursing home care.

Both assisted living and nursing homes work to keep a loved one safe, healthy, happy, and supported in their Activities of Daily Living (ADLs). These include help bathing, dressing, and with personal care.

The primary difference between assisted living and nursing homes is the amount and type of care provided. Assisted living environments feel more home-like, and rooms usually have a bathroom and kitchenette. Residents in assisted living keep much of their independence and participate in activities.

Agent tip:

“If finances are limited, you can apply for Medicaid in your state. Between long-term care insurance, personal funds, and Medicaid, we can help you discover long-term care options.“

Nursing home residents typically need 24-hour, around-the-clock care and monitoring. The medical care at nursing homes is typically more complex custodial care, requiring skilled nursing or specialists such as speech pathology, physical therapy, occupational therapy, and more.

Between these two options, you may see that one is better for your mother than another. If she’s not needing a nursing home now, and assisted living is a better option, then you may want to plan for that – with the eventuality of nursing home care.

To learn more about assisted living care, read “Does Medicare cover assisted living?”

Original Medicare and Medicare Advantage plans do not pay for nursing homes or assisted living care. And the cost is significantly different between assisted living and nursing homes. The average assisted living facility could cost $4,300 per month, while a nursing home averages between $7,908 per month for a shared room and $9,034 per month for a private room. That’s $51,600 per year for assisted living and between $94,896 and $108,408 per year for a nursing home.

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• Compare all major plans and carriers
• Local, licensed insurance agents with 25+ years of experience

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Many people enroll in long-term care insurance plans to pay for long-term nursing home care. This insurance can help pay for skilled and non-skilled care in various facilities. So, depending on your mother’s needs, a long-term insurance plan could help with nursing home care, adult day care, assisted living, medical equipment, and informal home care.

Alternatively, nursing home care can be paid for with personal funds. If funds are limited, your mother could qualify for Medicaid in your state. Qualifications vary from state to state, and you should check Medicaid eligibility in your state.

I hope this information was helpful. Funding care can be challenging, but it’s possible with long-term care insurance, personal funding, or Medicaid. And Connie Health is here to help you determine which option works best.

If you’d like to discuss the options, please call a licensed agent in your community. Connie Health agents are here to support you and your mother throughout the Medicare journey—call (623) 223-8884 to speak with an agent.

Sources

Does Medicare cover assisted living?
How can I pay for nursing home care?
Medicare Part A coverage—nursing home care
Nursing home care
Skilled nursing facility (SNF) care
What is the Difference Between Assisted Living and Nursing Homes?

Frequently Asked Questions

Does Medicare cover nursing home costs?

No, Original Medicare does not cover nursing home costs. These costs are typically covered through long-term care insurance, personal funds, or Medicaid. You may want to contact your state’s Medicaid office for eligibility requirements if finances are limited.

Does Medicare cover nursing home care for dementia?

No, Original Medicare does not cover nursing home care for dementia. 

Original Medicare does not cover 24-hour care. However, part-time at-home care is provided. Nursing home care for dementia is usually funded through long-term care insurance, personal funds, or Medicaid. Your state’s Medicaid office can help you determine Medicaid eligibility.