What Happens When Medicare Stops Paying For Nursing Home Care

Many seniors look to Medicare to help pay for their nursing home care. However, this program only covers up to a certain amount, which can create a financial burden when older individuals meet this limit. Whether they have additional conditions that require care or simply a longer stay in a nursing home, older individuals often must look for other forms of funding to pay for their healthcare needs. This guide offers details on what happens when medicare stops paying for nursing home care, along with tips on other forms of funding.

Skilled nursing care is medical care provided by registered nurses to patients who require rehabilitation and other medical treatments after being hospitalized for injuries and/or illnesses. This type of care is meant to be temporary and typically takes place in nursing homes, with nurses aiming to improve individuals' health and help them return home.

Skilled nursing care is not offered in independent living communities, and most memory care facilities and assisted living communities do not offer regular skilled nursing services. 

Medicare Part A, typically referred to as "hospital insurance," covers skilled nursing care under certain conditions for a limited amount of time. While skilled nursing care usually takes place in a nursing home, it will not cover long-term care in a nursing home facility. 

How long does Medicare pay for nursing home care? Your Medicare Part A deductible covers the first 20 days of skilled nursing care per benefit period. You will then have to pay a copayment for days 21-100 of skilled nursing care. In 2025, the copay will be $209.50. After that 100-day period, you will be responsible for the full cost of care. 

 

In addition to having Medicare Part A, there are certain Medicare conditions you need to meet in order to receive coverage. You must meet all of the following conditions:

• Have a qualifying inpatient hospital stay
• Enter a skilled nursing facility within 30 days of leaving the hospital
• Have an order from your doctor that you need daily skilled care
• Obtain skilled nursing care in a Medicare-certified skilled nursing facility
• Need services for an ongoing condition that was treated during your qualifying hospital stay, or a new condition that started while getting care for your current condition
• Need care or therapy to improve your current condition or prevent it from becoming worse

Medicare pays for several services to help treat and manage health conditions in the facility in which you are receiving care by skilled care nursing professionals. Medicare nursing home coverage includes services such as:

• Meals and dietary counseling
• A semi-private room
• Therapies, such as physical therapy and occupational therapy
• Medications
• Ambulance transportation to other services not available at your current facility
• Medical social services
• Speech-language pathology services
• Medical supplies and equipment

Medicare doesn't cover long-term stays in nursing homes. This is why Medicare coverage for skilled nursing care in a nursing home facility ends after 100 days. If your coverage ends and you still need care, financial assistance options like Medicaid, long term care insurance, VA benefits, at-home care, paying privately, and filing appeals can all help with costs.

Medicaid is a federal and state health insurance program for individuals with lower incomes. The income limits vary by state. Recipients can use Medicaid to cover nursing home care costs, but not every nursing home accepts Medicaid. Some people qualify for both Medicare and Medicaid. In these cases, Medicare pays first, and Medicaid pays last. 

Medicare Part A and/or Medicare Part B will often cover at-home services if you are "homebound." Services covered include physical therapy, occupational therapy, wound care, and medical social services. Once you pay the Medicare Part B deductible, you then pay 20% of the service. Note that the services you receive must be Medicare-approved. 

When your Medicare coverage ends, you can choose to pay out of pocket for care past the 100-day period — but this can be expensive. There are a few types of financial assistance that can help. Reverse mortgages, veterans benefits, Social Security benefits, and long-term care insurance can ease the financial costs.

You have the right to appeal if you think you need more care past the approved amount of time. In skilled nursing facilities, you can ask your provider for a fast appeal. Upon appealing, an independent reviewer in a beneficiary and family-centered care-quality improvement organization will determine if you should continue to receive care.

So, does Medicare cover nursing homes? Yes — under certain conditions. Medicare covers short-term nursing home stays for skilled nursing care. You are responsible for the total costs of care after a 100-day period. Medicaid, private pay, at-home care, and filing an appeal to extend care can help provide further financial assistance if necessary.

• Does Medicare cover nursing homes? What older adults and caregivers should know. (2024.) National Council on Aging
• Fast appeals. (n.d.). Medicare.gov. 
• Home health services. (n.d.). Medicare.gov.
• How can I pay for nursing home care? (n.d.). Medicare.gov. 
• Medicaid. (n.d.). Medicare.gov. 
• Price, Travis. How do I report a death to Medicare? (2022.). Medicareplans.com.
• Skilled nursing facilities. (n.d.). Medicare.gov. 
• Skilled nursing facility care. (n.d.). Medicare.gov. 
• What's the difference between a skilled nursing facility and a nursing home? (n.d.). uhc.com.