What Happens When Medicare Stops Covering Nursing Home Care

What Happens When Medicare Stops Covering Nursing Home Care

As you get older, there are a lot of decisions to make about your future that can be both exciting and daunting. But one of the most critical decisions is what happens when Medicare stops paying for nursing home care. This decision can have profound implications for your and your family’s financial security, comfort, and peace of mind. 

By understanding your options before this point comes, you can be better prepared to handle any changes that may arise. In this blog post, we’ll look at what happens when Medicare stops covering nursing home care and discuss the various options available to those affected by it.

Services Medicare Doesn’t Cover

Regrettably, Medicare does not cover custodial care, which is the primary type of care given in nursing homes. Custodial care involves assistance with daily activities such as bathing, dressing, eating, and toileting. Medicare also does not provide coverage for prolonged nursing home stays or skilled nursing facility care for individuals who need more advanced medical treatment.

It’s important to note that Medicare doesn’t cover items like contact lenses, eyeglasses, dentures, hearing aids, or white canes for the blind, even though they may be medically necessary. This means that those who need these items may have to pay for them out of pocket, and they can be quite expensive.

Custodial Care: Explanation

Custodial care is any type of non-medical care provided to elderly or disabled individuals who are unable to perform basic activities of daily living on their own. Examples of custodial care include help with bathing, dressing, transferring, eating, and using the bathroom. These services may be provided in a nursing home or the individual’s home, depending on their needs and preferences.

Nursing Home Care Demand on Rise

Due to the growing aging population, the demand for nursing home care is expected to increase significantly over the next decade. While many individuals prefer to stay in their homes as long as possible with assistance from family and friends, others will require more comprehensive medical and custodial care that can only be provided in a nursing home or other institutional setting.

Nursing Home Care: Real Cost Revealed

The cost of nursing home care in the United States is no small expense. The average monthly cost for a shared room in a private or semi-private nursing home is $7,908 per month. For a private room, the price increases to an average of $9,034 per month. These costs can add up quickly, and many seniors find themselves having to foot the bill out of pocket.

How Medicare Covers Nursing Home Care

Medicare covers nursing home care only if the patient has a medical necessity for skilled nursing care and gets it from a Medicare-approved skilled nursing facility.

Medicare Part A provides coverage for skilled nursing care for up to 100 days per benefit period. The first 20 days are fully covered, while the next 80 days require a daily coinsurance payment.

Please keep in mind that Medicare only covers nursing home care for short-term rehabilitation stays and not for long-term custodial care. To fully understand the coverage and limitations of nursing home care under Medicare, patients and their families should review the guidelines carefully and consult with healthcare providers.

How Medicaid Covers Nursing Home Care

Medicaid is a state-funded program that provides health care coverage and long-term care services to people with limited income and resources. In addition to covering nursing home care, Medicaid also covers home health services, personal care services, adult day care programs, and other types of community-based programs.

Unlike Medicare, Medicaid covers long-term custodial care in a nursing home, as well as skilled nursing care. Eligibility requirements vary by state, but Medicaid typically covers individuals who meet certain income and asset limits.

Medicaid is the primary payer of long-term nursing home care in the United States, covering over 60 percent of all nursing home residents. It is essential to understand the eligibility requirements and coverage limits in your state if you or a loved one is considering nursing home care.

Medicaid Eligibility Requirements

To be eligible for Medicaid, you must meet certain income and asset requirements. The requirements vary by state but typically include having an income below a specific level, as well as not having more than a certain amount of assets. In addition, some states also have age and disability requirements that must be met in order to qualify for coverage. 

Medicaid eligibility rules can be complex and challenging to understand, so it is important to consult with a Medicaid specialist who can assist you in determining your eligibility.

Long-Term Care Insurance to Help Pay for Nursing Home Care 

Long-term care insurance is a type of insurance policy designed to cover the cost of long-term care services, such as nursing home care. These policies typically provide coverage for a variety of services, including skilled nursing care, personal care services, in-home health care, and adult day programs.

Long-term care insurance is an essential financial tool for many individuals who are planning for their long-term care needs. Policies vary, so it is crucial to research and compare the different plans available in order to find one that meets your individual needs.

Discount Seniors Should Check Out

Ross’ Stores10% off on Tuesdays and Wednesdays55 and older
GEICOup to 25% off50+
Tractor Supply10% off55+
Golden Corral10% off55 or older
McDonald’sVaries by location55 or older


Nursing home care can be expensive, and it is important to understand the financial options available to help cover the costs. Medicare and Medicaid both provide coverage for nursing home care, but their coverage limits vary. Long-term care insurance is another option that can help cover these costs. 

No matter which option you choose, it is essential to understand the specific coverage limits and eligibility requirements to ensure that you receive the care you need.

It is also essential to speak with a financial advisor or long-term care specialist who can help you identify the best options for your individual situation, as well as provide guidance on how to access the available resources. With the proper planning, you can ensure that you get the care you need while protecting your financial security.

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