Supporting Information

About Medicare Coverage

Generally, Medicare doesn’t pay for long-term care. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Most long-term care is considered "custodial care". Custodial care is nonskilled, personal care, such as help with bathing, dressing, eating, getting in or out of bed or chair, moving around, and using the bathroom.

Medicare pays for medically-necessary care in a skilled nursing facility (SNF) for people with Medicare who require skilled nursing or rehabilitation services. Skilled care is given for a short period of time when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Examples of skilled care are intravenous injections and physical therapy.

To be covered for skilled care, you must receive the services from a Medicare-certified SNF after a qualifying hospital stay. A qualifying hospital stay means at least three days spent in a hospital just before going to a nursing home.

To learn more about Medicare payment for skilled nursing home costs, contact the Medicare Fiscal Intermediary or the State Health Insurance Assistance Program (SHIP) in your state. Their phone numbers are in the Helpful Contacts section of this website. For more information, see the Medicare publication called Medicare Coverage of Skilled Nursing Facility Care.

Other Ways to Pay for Care

Medicaid

Medicaid is a joint state and Federal program that will pay most nursing home costs for some people with limited income and resources. Medicaid will pay only for nursing home care provided in a facility certified by the government to care for people with Medicaid. Note: Not all nursing homes accept Medicaid payment. Eligibility for Medicaid varies by state. Call the SHIP for your state or call your State Medical Assistance (Medicaid) office. Their telephone number is in the Helpful Contacts section of this website.

Personal Resources

About half of all nursing home residents pay nursing home costs out of their own savings. After these savings and other resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Medicaid.

Managed Care Plans

A managed care plan won’t help pay for nursing home care unless the nursing home has a contract with the plan. If the home is approved by your plan, find out if the plan also monitors the home for quality of nursing care.

Medicare Supplement Insurance

This is private insurance. It's often called Medigap because it helps pay for gaps in Medicare coverage such as deductibles and co-insurances. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. Some people use employer group health plans to help cover nursing home costs.

Long-Term Care Insurance

This is a private insurance policy. The benefits and costs of these plans vary widely. For more information on these plans, contact the National Association of Insurance Commissioners (NAIC). It represents state health insurance regulators and has a free publication called “A Shopper's Guide to Long-Term Care Insurance.” Visit www.naic.org/consumer_home.htm.

Counseling and Assistance

Your State Health Insurance Assistance Programs (SHIP) has counselors who might be able to answer your questions about how to pay for nursing home care, the coverage you may already have, or whether there are any government programs that will help with your expenses. Their phone number can be found in the Helpful Contacts section of this website.

For more information about long-term care, nursing home care, and skilled nursing facility care, see the publication called Medicare's Guide to Choosing a Nursing Home.

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