Does Medicare Cover Nursing Homes?
Medicare does not pay for most long-term nursing home (custodial) care. It can, however, cover short-term skilled nursing facility (SNF) care after a qualifying hospital stay, provided the clinical criteria are met. Understanding this difference helps Wichita families plan for both short-term recovery and longer-term support needs.
If you’re comparing short-term rehab, long-term nursing care, or assisted living, talk with Keepsake Kottage Home Plus or call (316) 650-4526 to discuss options that fit your situation.
What Medicare Covers in a Nursing Facility
Medicare may cover short-term skilled nursing facility (SNF) care after a qualifying hospital stay, provided that professional services are medically necessary to treat a specific condition. Coverage can include…
- Skilled nursing and rehabilitation (physical, occupational, speech therapy)
- Medications, medical supplies, and specific equipment are used during the stay
- Medically necessary tests and treatments related to the qualifying condition
This coverage is meant for recovery and rehabilitation, not for long-term residency.
What Medicare Does Not Cover
Medicare generally does not cover long-term custodial care in a nursing home, help with Activities of Daily Living such as bathing, dressing, eating, and mobility, when it’s the only needed service. It also does not pay for room and board in custodial long-term stays.
Key Requirements for SNF Coverage
- Qualifying hospital stay – A prior inpatient hospital stay is typically required before SNF coverage begins (verify current Medicare rules).
- Medical necessity – Skilled services must be reasonable and necessary for your condition, with ongoing improvement expected or skilled management required.
- Medicare-certified SNF – The facility must be certified by Medicare.
- Coverage periods & cost sharing – Deductibles and copays may apply; coverage length is limited and subject to periodic reassessment.
Alternatives & Planning for Long-Term Care
- Medicaid (eligibility-based) – May help with long-term nursing facility costs depending on income, assets, and clinical need. Apply early if close to qualifying.
- Long-term care insurance – Policies may reimburse eligible services in nursing facilities or assisted living once benefit triggers are met.
- Private pay & benefits – Social Security, pensions, retirement savings, and veterans’ benefits often combine to cover ongoing needs.
- Assisted living – For seniors who need daily support but not 24/7 skilled nursing. See the section below.
Assisted Living vs. Nursing Home
Assisted living provides daily support (meals, medication reminders, personal care) with 24/7 staff presence, but it is not a hospital or skilled nursing facility. Nursing homes provide 24/7 licensed nursing care for individuals with complex or unstable medical conditions. Many families start with assisted living and transition to higher acuity care only if needs outgrow licensing limits.
Explore a smaller, home-like option in Wichita at Keepsake Kottage Home Plus.
FAQs: Medicare & Nursing Homes
Does Medicare pay for long-term nursing home care?
No. Medicare does not pay for custodial long-term residency. It covers short-term skilled care when criteria are met.
What about rehab after a hospital stay?
Medicare may cover a limited SNF stay after a qualifying hospital stay if skilled services are medically necessary.
Can Medicaid help with long-term nursing home costs?
Yes, if financial and clinical eligibility are met. Apply early and confirm current program rules.
Is assisted living covered by Medicare?
Medicare does not cover room and board in assisted living facilities and typically does not cover ongoing custodial care.
How do I decide between assisted living and a nursing home?
Match the care setting to needs: choose assisted living for daily support and safety; nursing homes for continuous skilled nursing and complex medical care.
Disclaimer
This article provides general information and is not medical, legal, or financial advice. Medicare rules and program details are subject to change over time. Always verify current coverage with Medicare and your providers, and consult qualified professionals.
