Does Medicare Pay for Long-Term Nursing Home Care?

Needing long-term nursing home care is stressful. Paying for it is even more so. According to the Department of Health and Human Services' National Clearinghouse for Long-term Care Information, as of 2009, a semi-private room in a nursing home is, on average, $198 per day. With inflation, costs continue to rise. Medicare covers most medical costs for those who qualify, but nursing home care, in general, is not covered. There are a few exceptions, though, and it's important to consider alternatives to nursing home care.

What Medicare Covers

• Medicare will cover skilled nursing facility care for up to 100 days. According to Medicare, skilled nursing can only be care provided under the supervision of a registered or licensed practical nurse. For Medicare to cover a skilled nursing stay, it must follow a hospital stay and you must be getting progressively better. Medicare will cover the first 20 days completely, there is a co-pay for each day after 20, and no coverage at all after 100 days.

What Medicare Doesn't Cover

• Medicare does not cover custodial nursing home care. Custodial care assists you with daily activities. These may include bathing, toileting, dressing or eating. This type of care doesn't need direct supervision by a registered nurse or LPN; certified nursing assistants typically handle it. Medicare will continue to cover any medical care you receive, such as a doctor visit, but not the cost of a facility stay.

Alternative Care Options

• If you're looking at care options, one alternative is home care, rather than in a facility. Nursing aides can come into the home, with additional support provided by friends or family. This can be less expensive than a nursing home, depending on the amount of care required. Adult Day Care is another option that allows you to remain at home in the evenings and on weekends, but have support during the day, when family members may be at school or work. This is also less expensive than nursing home care.

Alternative Payment Options

• Most of us end up paying for long-term care out-of-pocket, but there are alternatives. Long-term care insurance policies can ease the burden, but you must purchase them well before the need for care arises. Medicaid also pays for a significant portion of long-term care. Medicaid provides low-cost medical coverage to those with limited incomes and very few assets. Medicaid, unlike Medicare, does cover nursing home care. If you think you may qualify, you can inquire with your state's department of aging for information on how to apply.