Does Medicare Pay for Nursing Homes?

At some point after retirement, many of us will need long-term nursing care. Often this means moving into a nursing home on a full-time basis, and sometimes for many months or years. So you might be wondering if Medicare coverage includes nursing home care, and/or how much you can expect from the program.

Generally speaking, no, Medicare does not cover the cost of a nursing home.  But that doesn’t mean people who receive Medicare can’t receive help paying for their stay.

First, you should understand that your Medicare coverage will continue while you live in a nursing home, even though it doesn’t cover the cost of the facility itself. When you visit a doctor or require prescription medications, Medicare will indeed cover those services to the extent that your plan has always done (prescriptions are subject to a Part D plan).

As for the nursing home itself, you have several options to pay for that expense.

Depending upon your income and personal resources, you might qualify for Medicaid (MediCal in California). Even if you haven’t qualified for Medicaid in the past, you should apply. The income limits are higher for those living in a nursing home. If you do qualify, Medicare pays for many (but not all) nursing homes. Just check with your preferred facility first to be sure it does accept Medicaid paymetns.

Otherwise, you will be responsible for the cost of your long-term nursing care. Because Medicare coverage does not extend to nursing homes, investigate long-term care insurance now. Rates will climb as you get older, so locking in a policy as early as possible is key to managing your premiums.

And if you don’t qualify for Medicaid or have long-term care insurance, you will become personally responsible for the cost of a nursing home in the event that you need one. This is one of the many reasons that thorough retirement planning is so important.

For more on Medicare coverage, such as what your plan does and does not cover, call us to speak with one of our knowledgeable brokers. We can help you understand your plan, as well as its limits, so that you can budget for unexpected expenses in the future.

Posted by PGIA
12 months ago / March 1, 2023

Filed Under: Medicare Info