This is one of the most misunderstood parts of Medicare. Here's the crucial difference between skilled and long-term care.
What nursing home care does Medicare cover?
Medicare Part A covers short-term care in a skilled nursing facility, but only under specific conditions. You must have a qualifying inpatient hospital stay of at least three days, then enter a Medicare-certified skilled nursing facility within 30 days for skilled care related to that hospital stay. Medicare covers up to 100 days per benefit period: days 1 through 20 are fully covered, and days 21 through 100 require a daily coinsurance. This is meant for rehabilitation and skilled recovery, such as after a stroke or surgery, not indefinite residence. A Medigap plan can cover the daily coinsurance. Call 1-800-MEDIGAP at 1-800-633-4427.
Why Medicare doesn't cover long-term nursing home care
Most nursing home care is custodial care, help with daily activities like bathing, dressing, eating, and using the bathroom, when that's the main care you need. Medicare does not cover custodial or long-term care, even in a nursing home. This is a frequent and costly surprise for families. Long-term nursing home care is most often paid through Medicaid (for those who qualify financially), long-term care insurance, or personal savings. Planning ahead is essential because nursing home costs are substantial. To explore how to protect yourself and your family from these costs, call 1-800-MEDIGAP at 1-800-633-4427 for free guidance.