Nursing Home Care Not Covered by Medicare

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Many people are surprised, and often alarmed, to learn that Medicare doesn’t cover long-term care in nursing homes. This does not mean short-term stays in a skilled nursing facility (most of which are nursing homes) after leaving the hospital; Medicare does cover those stays in specific circumstances.

But what if you become too sick or incapacitated to live at home and need the constant long-term care that a nursing home provides?

Medicare will continue to cover your medical needs, but it won’t pay for what it calls custodial care, which refers to help with the activities of daily life such as using the bathroom, dressing, and so on. Nor will Medicare pay for your room and meals in a nursing home. These same rules apply to assisted living facilities.

Most people living in nursing homes pay for their custodial care out of pocket — with the help of long-term care insurance, if they’ve purchased it — until their resources run dry.

At that point, they usually become eligible for Medicaid, the state-run health care system for people with very limited incomes and resources, which does pay the custodial care bills of people who qualify. (Because of the similarity in names, many people confuse Medicare and Medicaid, especially when it comes to thinking about long-term care.)

Eligibility rules for Medicaid vary from state to state. (And the name of the program is different in some states — for example, MediCal in California, MassHealth in Massachusetts, and TennCare in Tennessee.) To find out how the rules apply to you or a family member, you may need to consult an informed counselor or a qualified elder care attorney.

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