When you or a loved one needs nursing home care, one of the first questions that comes to mind is: “Will Medicare help pay for this?” It’s a question that weighs heavily on many families, and honestly, the answer isn’t quite as simple as yes or no.
Medicare does cover some nursing home care—but only under specific conditions, and typically for a limited time.
Let’s walk through this together. We’ll break down exactly what Medicare covers, how long that coverage lasts, and what options you have when Medicare stops paying. Whether you’re planning ahead or facing this decision right now, understanding your coverage can help you make informed choices about care.
What Kind of Nursing Home Care Does Medicare Actually Cover?
Medicare generally covers what’s called skilled nursing facility care, but it doesn’t cover long-term custodial care. So what’s the difference?
Skilled nursing care means you need medical services that can only be provided by or under the supervision of a registered nurse or other skilled medical professionals. We’re talking about things like wound care, physical therapy, speech therapy, or IV medications. This is medical care that requires professional expertise.
On the other hand, custodial care is help with daily living activities—things like bathing, dressing, eating, or getting in and out of bed. While these services are absolutely essential and valuable, they’re not considered medical treatment, which means Medicare doesn’t cover them for extended periods.
Understanding this distinction is key because it shapes everything about your coverage and what you’ll need to plan for financially.
Medicare Part A and Hospital Insurance
Medicare Part A, often called hospital insurance, is the part of Medicare that can help pay for nursing home stays. But there’s a catch—actually, there are several conditions you need to meet before Medicare coverage kicks in.
First, you need what’s called a qualifying hospital stay. That means you must have been an inpatient in a hospital for at least three consecutive days (not counting the day you’re discharged). This hospital stay has to happen before you’re admitted to the skilled nursing facility, and you generally need to move to the nursing home within 30 days of leaving the hospital.
Second, you need to require skilled nursing care or skilled rehabilitation services on a daily basis. Your doctor has to certify that you need this level of care, and the nursing home must be Medicare-certified. Not all nursing homes accept Medicare, so that’s something to verify.
When these eligibility requirements are met, Medicare Part A steps in to help cover the costs. But remember—this coverage has time limits that we’ll get into next.
How Many Days Will Medicare Pay?
So how many days of nursing home care will Medicare cover? The answer is up to 100 days per benefit period—but it’s not quite as straightforward as it sounds.
For the first 20 days of your stay in a skilled nursing facility, Medicare covers the full cost. You don’t pay anything out of pocket during this time, which can be a huge relief when you’re already dealing with health challenges and recovery.
But here’s where it changes. From day 21 through day 100, Medicare still provides coverage, but you’ll need to pay a daily coinsurance amount. As of 2024, this coinsurance is $200 per day, though these amounts can change yearly. That adds up pretty quickly—we’re talking about potentially $16,000 over those 80 days.
After day 100, Medicare coverage ends completely for that benefit period. Once Medicare stops paying, you become responsible for the full cost of your care, which can vary widely depending on where you live and what level of care you need.
So, to summarize how Medicare pays for your nursing home stay:
The First 20 Days
- Medicare covers the full cost
- You pay nothing out of pocket
- No coinsurance or copayment required
Days 21 Through 100
- You pay $200 per day coinsurance (2024 rate)
- Medicare covers the remaining approved costs
- Your total: up to $16,000 for these 80 days
After Day 100
- Medicare coverage ends completely
- You pay the full daily rate
- Average cost: $6,000-$8,000 per month in Louisiana
What Exactly Is a Benefit Period?
The term “benefit period” confuses a lot of people, so let’s clarify. A benefit period begins the day you’re admitted to a hospital or skilled nursing facility and ends when you haven’t received inpatient care for 60 consecutive days.
Here’s why this matters: you can start a new benefit period if you meet the requirements again. That means if you’ve fully recovered and then later need another hospital stay followed by skilled care, you could potentially get another round of Medicare coverage. There’s no limit to how many benefit periods you can have throughout your life, but each one requires that qualifying hospital stay and the need for skilled nursing.
Think of it this way—each benefit period is like hitting a reset button, but only after you’ve been out of inpatient care for those 60 consecutive days.
Medicare Advantage Plans
If you have a Medicare Advantage plan (sometimes called Medicare Part C), your coverage might work a bit differently. These plans are offered by private insurance companies approved by Medicare, and while they must cover everything Original Medicare covers, they often provide additional benefits.
Many Medicare Advantage plans include coverage for skilled nursing facility care with similar rules to traditional Medicare. However, your plan might have different cost-sharing arrangements or may require you to use nursing homes within their network. Some Medicare Advantage plans also offer limited coverage for custodial care or assistance with daily living—something Original Medicare doesn’t cover at all.
It’s worth reviewing your specific Medicare Advantage plan details or talking with your plan representative to understand exactly what’s covered and what your out of pocket costs might be.
What Medicare Doesn’t Cover
Here’s where we need to be really clear about what Medicare won’t pay for, because this is where families often get surprised. Medicare doesn’t cover long-term custodial care in nursing homes. If you need help with daily activities but don’t require ongoing skilled medical care, you’ll need to find other ways to pay.
Medicare also doesn’t cover private rooms unless they’re medically necessary. You typically won’t get coverage for personal care items, phone or television charges, or personal services that aren’t related to your medical treatment. And importantly, Medicare Part B (which covers outpatient care and medical supplies) might cover some services while you’re in a nursing home, but it won’t pay for the room and board.
The reality is that most nursing home residents eventually need long-term care that goes beyond what Medicare covers. That’s why it’s so important to plan ahead and understand your other payment options.
What To Do When Medicare Coverage Ends
When your Medicare coverage ends—whether that’s after 100 days or when you no longer need skilled care—you’re not out of options, but you do need to figure out how to cover the costs. And let’s be honest, nursing home costs can be substantial. In Louisiana, the average cost for a private room in a nursing home runs around $6,000 to $8,000 per month, and that can go even higher depending on your specific care needs.
So what can you do? Many people pay out of pocket using personal savings. Others might sell assets, use reverse mortgages, or rely on help from a family member. Some nursing home residents transition to Medicaid once their resources are spent down, which we’ll talk about in a moment.
This transition period when Medicare stops paying can feel overwhelming. It’s one of those times when having a solid plan in place really makes a difference. You might want to talk with an elder law attorney who can help you understand your options and navigate the financial aspects of long-term care.
Planning for the Future Through Long-Term Care Insurance
One way people plan for potential nursing home costs is through long-term care insurance. These policies are specifically designed to cover services that Medicare doesn’t—like help with daily living activities and extended nursing home stays.
Long-term care insurance works best when you buy it before you actually need care, typically when you’re in your 50s or early 60s. The policies vary widely, so you’ll want to read the fine print carefully. Some cover only nursing home care, while others also include home care or assisted living.
The premiums for long-term care insurance can be expensive, but for some families, having this coverage provides real peace of mind. It means you won’t have to deplete your savings or rely entirely on your family to cover care costs down the road. That said, not everyone can afford these policies, and they’re definitely not the only kind of planning you can do.
Medicaid: Coverage for Those with Limited Income
While Medicare has strict limits on what it covers, Medicaid services work differently. Medicaid is a joint federal and state program designed to help people with limited income and assets pay for medical care, including long-term care in nursing homes.
Unlike Medicare, Medicaid can cover long-term custodial care—the kind of daily assistance that most nursing home residents eventually need. But qualifying for Medicaid requires meeting specific income and asset limits, which vary by state. In Louisiana, there are certain exemptions and protections, particularly for a spouse who continues living in the community.
Many people start out paying for nursing home care with Medicare or private funds, then transition to Medicaid once their resources are spent down. It’s a common pathway, though it requires careful planning and documentation. An elder law attorney can help you understand Louisiana’s specific Medicaid rules and how to protect assets while qualifying for benefits.
Working with someone who knows the ins and outs of this state program can make the process much less stressful. They can help you understand the spend-down process, protect your home if possible, and navigate the application process.
Additional Payment Options and Resources
Beyond Medicare, long-term care insurance, and Medicaid, there are other resources that might help cover nursing home costs. Veterans benefits, for example, provide additional support for qualifying veterans and their surviving spouses. The Aid and Attendance benefit can help pay for nursing home care, home health care, or care in your own home.
Some people use health care savings accounts or investments they’ve set aside specifically for health care costs. Life insurance policies might have riders that allow you to access benefits early if you need long-term care. And some families explore creative payment options like family care agreements, where a family member provides care in exchange for compensation from the person receiving care.
The key is to explore all your options and combine different resources if needed. What works for one family might not work for another, and that’s okay. The important thing is finding a plan that works for your specific situation.
Why Planning Ahead Matters
When planning for retirement, but we don’t always think about planning for the possibility of needing nursing home care. Yet it’s one of the most important conversations families can have.
When you plan ahead, you have time to explore options like long-term care insurance while you’re still healthy enough to qualify at reasonable rates. You can have honest conversations with your family about your wishes and preferences. You can work with financial planners or an elder law attorney to structure your assets in ways that protect your resources while ensuring you’ll qualify for programs like Medicaid if needed.
Planning also means understanding the real costs involved and how long your savings might last. It means researching nursing homes in your area, understanding what Medicare and other programs will actually cover, and identifying the gaps you’ll need to fill with other resources.
How St. Margaret’s Family of Care Can Support You
At St. Margaret’s Family of Care, we understand that navigating Medicare coverage and payment options can feel overwhelming. That’s why we’re here to help guide you through the process. Our team has experience working with Medicare, Medicare Advantage, Medicaid, and private payment options.
We accept Medicare and work with nursing home residents and their families to understand what’s covered and what costs they might face. Our locations—St. Margaret’s at Mercy in Mid-City, St. Jude’s, and St. Luke’s—all provide skilled nursing facility care in warm, household-style environments where people feel truly at home.
Beyond just skilled nursing, we offer hospice and in-home hospice services, outpatient care, and rehabilitation. At St. Margaret’s at Mercy, we even have an on-site pharmacy to make managing medical supplies and medications easier. Whether you need short-term recovery after a hospital stay or continued care over a longer period, we’re here to provide the medical care and personal support you deserve.
We’ve been serving New Orleans families since 1889, and in that time, we’ve learned that every person’s situation is unique. We take the time to understand your specific needs, work with your health care providers, and help you understand your coverage and payment options.
If you’re wondering whether Medicare will cover your nursing home stay or how long that coverage might last, we encourage you to reach out. Our team can review your specific situation and help you understand what to expect. We can also connect you with resources in the community—whether that’s an elder law attorney, information about veterans benefits, or guidance on Medicaid services.
The bottom line is this: yes, Medicare can help pay for nursing home care, but it’s typically limited to 100 days per benefit period and only covers skilled nursing facility care. For most people, that means planning for what comes after Medicare coverage ends. And that’s where having knowledgeable, caring partners makes all the difference.
At St. Margaret’s Family of Care, you’re not just a nursing home resident—you’re part of our family. We’re committed to providing compassionate, qualified care while helping you and your loved ones navigate the complex world of health care coverage and costs. Because at the end of the day, everyone deserves access to quality care delivered with dignity and respect.