If you or a loved one are in need of assisted living, you may be wondering what Medicare covers.
Medicare does not cover custodial care (long-term care) — which includes assistance with all the daily tasks of living — if this is the only type of care you need. However, if you are spending time in a nursing home or assisted living facility, Medicare will cover your Part A and B medical needs as well as your Part D prescription drug needs while you are there.
Medicare covers skilled nursing facility (SNF) care for a short period of time if it is ordered by your doctor. The qualifications are that:
- You are admitted after a qualifying hospital stay of at least 3 days
- The skilled nursing facility is certified by Medicare
- The SNF is treating the same problem that brought you into the hospital
- You need skilled care on a daily basis
- You have covered days remaining under Part A
As long as your stay is deemed medically necessary, Medicare will:
- Cover the first 20 days
- Charge $185.50 in 2021 in coinsurance for days 21 -100 (some Medigap plans will cover part of this cost)
- After 100 days, Medicare will not pay
If you are stuck and need other options for long-term care, see if you qualify for Nursing Facility Medicaid or the PACE program. Or look into getting long-term care insurance (you must have the coverage before you need long-term care).