Original Medicare (Parts A & B): Nursing Home Care

Medicare doesn't cover custodial care, if it's the only care the member needs. Most nursing home care is custodial care, which provides assistance with activities of daily living, like bathing, dressing, toileting, and eating, or personal needs that could be done safely and reasonably without professional skills or training.  

Medicare Part A may cover care in a certified skilled nursing facility (SNF), which differs from a nursing home. To receive SNF care, it must be determined by a provider to be medically necessary, like changing sterile dressings, for example.

So, who covers nursing home care?

• Medicaid - Medicaid is a completely separate program from Medicare, and is available to very low income people with few assets other than their house. If you or your loved one meets the financial requirements, Medicaid can fully cover long-term care, either in a nursing home or at home.

• Private insurance - Long-term care insurance (LTCI) is offered by private companies to pay for nursing care at home or in a facility. Premiums can be expensive, especially for those who purchase LTCI policies later in life.

• Veterans Affairs (VA) benefits - If the member qualifies for VA benefits, contact your local Department of Veterans Affairs office for potential nursing home care coverage.

• Medicare Advantage plans (Part C) - MA plans may cover some nursing home care, though plans typically don't pay for this care unless they have contracted with the nursing home. 

• Private pay - you or your loved one pays out-of-pocket for all nursing home care costs (can run from $5,000-$25,000 per month).