I'm caring for someone
Who pays for a nursing home?
Photo: Vitaly Gariev / Pexels
Usually your parent, until their savings run low, then Medicaid. Medicare pays only for short skilled care after a hospital stay, not for long-term help with daily living.
What to do
- Find out which kind of care your parent needs: skilled care (nursing or therapy a doctor orders) or custodial care (help with bathing, dressing, eating). Medicare does not pay for custodial care alone.
- Check the hospital stay. Medicare covers skilled nursing care only after at least 3 days in a row as an admitted inpatient. Nights 'under observation' do not count, so ask the hospital which status your parent has.
- Look for other ways to pay: a long-term care insurance policy, VA benefits if your parent is a veteran, or a life insurance policy with a long-term care rider.
- Ask your state Medicaid office about Medicaid for long-term care, including the asset limit and the 5-year look-back on gifts and transfers. An elder law attorney can help with the details.
What to say
Before we sign anything, can you tell me in writing what the daily rate includes, whether you accept Medicaid, and what happens if my parent's money runs out?
Ask before admission. If the facility accepts Medicaid, your parent may be able to stay when private funds run out.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Assuming Medicare pays for the nursing home. It does not pay for long-term custodial care, and its skilled-care coverage stops when your parent no longer needs daily skilled care, which can be well before the 100 days are up.
Better done together
We’re here to help
Paying for a nursing home is one of the biggest decisions a family makes, and the rules on Medicare, Medicaid and savings are easy to misread. We help you understand the options early, so you can plan instead of react.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
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The rule behind it
Medicare covers a skilled nursing facility only after a medically necessary inpatient hospital stay of at least 3 days in a row, for up to 100 days per benefit period: days 1 to 20 at no daily cost, then a daily copay. It pays only while your parent needs daily skilled care. Medicaid must cover nursing home care for people who meet their state's income and asset rules, and states look back 5 years at money given away. Some Medicare Advantage plans waive the 3-day rule; your parent's Evidence of Coverage says whether theirs does.
Sources
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Long-term care
- Medicare.gov — Inpatient or outpatient hospital status
- Medicaid.gov — Nursing facilities
- CMS.gov — Transfer of assets in the Medicaid program (60-month look-back)
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.