What Happens When Medicare Stops Paying for Nursing Home Care

• Grappling with the reality

• 1. Understanding Medicare and nursing home care
  • 1.1 What is Medicare?
  • 1.2 What are nursing homes?
• 2. Medicare coverage for nursing home care
  • 2.1 The extent of Medicare coverage
  • 2.2 Costs associated with nursing home care under Medicare
• 3. Average nursing home costs
• 4. What happens when Medicare stops paying for nursing home care?
  • 4.1 Medicaid
  • 4.2 State assistance programs
  • 4.3 Long-term care insurance
  • 4.4 Medicare Supplement (Medigap) plans
  • 4.5 Veterans Affairs
• 5. Conclusion

Grappling with the reality

Nursing home care costs catch many families off guard. Medicare pays for short-term skilled nursing stays, but not long-term residential care. When coverage ends, families need to know what options remain. This guide breaks down what Medicare covers, what it doesn't, and how to pay for care once benefits run out.

Understanding Medicare and nursing home care

What is Medicare?

Medicare is a federal health insurance program for people 65 and older, plus some younger people with disabilities or specific conditions. It covers hospitalization and skilled nursing care.

What are nursing homes?

Nursing homes, or skilled nursing facilities (SNFs), provide medical care and help with daily activities for people who cannot live independently. Services include assistance with bathing, meals, and dressing; nursing care; and physical therapy.

Medicare coverage for nursing home care

The extent of Medicare coverage

Medicare Part A covers up to 100 days of care in a skilled nursing facility per benefit period, but only after a qualifying hospital stay. This is not open-ended coverage. Once you reach day 101, Medicare pays nothing. After day 100, you or your family must pay the full cost.

Costs associated with nursing home care under Medicare

Days 1 through 20 are fully covered by Medicare Part A. From day 21 through day 100, you pay a daily coinsurance amount (up to $204 per day in 2023). All costs after day 100 are your responsibility.

Average nursing home costs

A semiprivate room runs about $94,900 per year; a private room about $108,405, according to 2023 data from Genworth Financial. Costs vary widely by region and state.

What happens when Medicare stops paying for nursing home care?

Once Medicare coverage ends at day 100, you need another way to pay. Below are the main options.

Medicaid

Medicaid is a federal-state program that covers medical costs for people with low income and limited assets. For those eligible for both Medicare and Medicaid, most nursing home costs are covered. But Medicaid has strict income and asset limits, and rules vary by state.

State assistance programs

Many states offer programs to help residents access long-term care while keeping some assets. These can open the door to Medicaid coverage while protecting a portion of savings.

Long-term care insurance

Long-term care policies cover both skilled and nonskilled care, but rarely pay for the full cost of nursing home care. Premiums can be steep.

Medicare Supplement (Medigap) plans

Medigap plans fill gaps in Original Medicare coverage. Some policies cover your coinsurance cost for days 21 through 100 of skilled nursing care.

Veterans Affairs

Veterans receiving a VA pension may qualify for the Aid and Attendance or Housebound allowance, which can help pay for nursing home care if they meet the eligibility criteria.

Conclusion

Medicare covers only the first 100 days of skilled nursing care per benefit period, and even then with limits. The rest falls on you. Planning ahead means knowing whether Medicaid, insurance, state programs, or other resources will cover the gap. Without a plan, nursing home costs can drain savings quickly.