Long-term care is generally not covered by Medicare. Most long-term care is considered to be custodial care (nonskilled personal care), such as help with bathing, getting dressed, eating and moving around. Medicare does not pay for custodial care.
Most nursing home care is also considered custodial, so it is not covered by Medicare. One of the few times it is available is if a beneficiary requires skilled care. A hospice patient on Medicare may be moved to a Medicare-approved nursing home if respite care is needed (when a caregiver needs a break).
Medicare will only pay for medically necessary skilled nursing facility care, and is usually only available for a short time following a hospitalization. Skilled care is health care given when people need skilled staff to monitor their conditions (for example, changing a sterile dressing or while in physical therapy).
For example, if someone breaks a hip, Medicare will cover the stay in the hospital, a hip replacement, and recovery and rehabilitation care in a skilled nursing facility. As of 2013, Medicare covers up to 100 days in a skilled nursing facility, and the patient receives full coverage for the first 20 days in the facility. From days 21 to 100, the patient pays $148 per day, and Medicare pays the rest. After 100 days, the patient must pay the full cost of staying in the facility. In contrast, if that person’s memory becomes a secondary issue (such as becoming forgetful or easily lost), he or she may be placed in a nonskilled nursing home. The nursing home offers custodial care, not medical care; therefore, Medicare will not pay for those bills.
If the person uses all of his or her funds to pay the nursing home bills until only approximately $2,000 remains in the bank, there is the probably of qualifying for Medicaid. At that point, the state will pay the nursing home bill and the person will become a dual eligible (enrolled in both Medicare and Medicaid).
Related FAQs
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What Are the Coverage Limits for Hospice Care?
What Are the Coverage Limits for Skilled Nursing Facilities?
