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Does Medicare pay for nursing home stays?

Juliet Wilkinson
Oncology Nursing

I would like to add to the previous answers to this question in reminding about the Medicare hospice benefit -- Medicare Part A. Those who are enrolled in a Medicare-approved hospice program may have different benefits as pertaining to their nursing home coverage. The Medicare hospice benefit covers a portion of respite, which is down-time for your caregivers, or it will cover brief stays as ordered by the hospice team for pain or symptom management. When in doubt ask for clarification.

Dr. Michael Roizen, MD
Internal Medicine

Medicare provides limited coverage for nursing home stays. You must have a need for skilled services and receive service from a skilled nursing or rehabilitation facility following a qualifying hospital stay -- the time spent in a hospital immediately before you transfer to a nursing home. The prior hospital stay must be a minimum of three days. Keep in mind, though, that Medicare doesn’t cover custodial or long-term care.

Better yet, try Programs of All-Inclusive Care for the Elderly (PACE). This program provides coverage of nursing home stays, prescription drugs, and other medical costs so older people can remain in their communities.  PACE is a partnership of Medicare and Medicaid, federal assistance to help low-income families pay health costs, and is offered in many states but not all. To qualify for PACE, you must be 55 or older, live in a PACE service area, and need nursing home care. 

To find a PACE program and learn about eligibility, call your State Medical Assistance (Medicaid) office or visit www.pace4you.org. You can also order “Quick Facts about Programs of All-Inclusive Care for the Elderly (PACE)” by calling Medicare at 1-800-633-4227 or online at http://go.usa.gov/loL.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.