Does Medicare pay for long-term nursing home care?

When families begin exploring long-term care options for a loved one, one of the first questions they ask is whether Medicare will cover the cost. At Texas Quality Home Health in Waco, we help clients navigate these concerns every day. Understanding what Medicare does and doesn’t cover is essential to planning appropriately for your future or the future of a loved one.

What Medicare Covers for Nursing Home Care

Medicare provides coverage for skilled nursing facility care under very specific circumstances. In general, it will cover up to 100 days of care in a skilled nursing facility, but only if certain conditions are met. These include a qualifying three-day inpatient hospital stay and a physician’s order that skilled care is medically necessary. During this time, Medicare pays for the first 20 days in full and contributes a partial payment for days 21 through 100. This coverage is designed to help individuals recover from surgery, illness, or injury and is not meant to serve as a solution for ongoing, non-medical care.

What Medicare Does Not Cover

It is important to understand that Medicare does not cover long-term custodial care. This includes services like bathing, dressing, eating assistance, or general supervision that a person may need if they are no longer able to care for themselves. Medicare also does not pay for care in an assisted living facility, adult day care, or other residential care that is not deemed medically necessary. Many people are surprised to learn that once those initial 100 days in a skilled nursing facility are used, they will be responsible for the full cost of ongoing care if no other resources are available.

What to Do When Medicare Runs Out

When Medicare no longer covers nursing home costs, families typically turn to other options such as Medicaid, long-term care insurance, or personal funds. Medicaid is a joint federal and state program that can help pay for long-term care, but applicants must meet strict income and asset requirements to qualify. In some cases, individuals must “spend down” their assets to become eligible. Long-term care insurance is another option, but it must be purchased long before care is needed and often comes with high premiums. Personal savings, retirement funds, and assistance from family are also commonly used to cover costs once Medicare coverage ends.

Why Planning Ahead Matters

The cost of long-term nursing home care can be substantial, especially in Texas where monthly costs can range from $5,000 to $10,000 or more depending on location and level of care. That’s why it’s so important to plan ahead. Speaking with a care coordinator, financial advisor, or insurance expert can help you understand the best steps to take now to avoid financial strain later. Many families wait too long to explore their options and are forced to make quick decisions in stressful situations. Planning ahead can ensure peace of mind and better outcomes for everyone involved.

Alternatives to Nursing Homes

In some cases, home health services can offer a viable and more affordable alternative to nursing home care. At Texas Quality Home Health, we provide skilled nursing, physical therapy, occupational therapy, and other health services right in the patient’s home. For individuals who qualify, some of these services may be covered by Medicare under Part A or Part B. Our team can work directly with your physician to coordinate care and develop a plan that keeps you or your loved one comfortable and independent for as long as possible.

Conclusion

While Medicare does offer short-term coverage for skilled nursing care, it does not pay for long-term custodial care in a nursing home. Understanding this distinction is critical when preparing for long-term health needs. At Texas Quality Home Health, we’re here to help families in Waco navigate these complex decisions and find the right solutions for their loved ones. Contact us today to discuss your long-term care options and how we can help.