Will Medicare Pay for a Nursing Home?

Understanding if and what part of nursing home care Medicare will pay for is very confusing. It is also one of the first big concerns Dallas- Fort Worth area families typically have when they begin searching for a nursing home. We thought it would help caregivers if we provided a quick overview of how Medicare works when it comes to nursing home care.

Medicare & Nursing Homes

In general, Medicare only covers what is referred to as “medically-necessary care.” Unfortunately, this means Medicare will not pay for long-term care in a nursing home. It will only cover rehabilitative care on a short-term basis. For most families, this is a real eye-opener.

Here is a quick look at what expenses Medicare will cover in a nursing home:

Medicare Part A: Short-term Rehab: If a senior meets several conditions, Medicare will pay for at least a portion of the first 100 days of short-term rehab. The first 20 days of care and services are covered in full. If the older adult needs more than 20 days of care, a co-pay will be assessed beginning on the 21st day. There is no Medicare coverage at all beyond day 100.

Medicare Part B: Outpatient Therapy: If an older loved one resides in the long-term care section of a nursing home or will soon be making a move to one, their Medicare Part B benefit may cover short term physical or speech therapy if needed and their physician orders it. This care would be covered under their outpatient therapy benefit. Be certain you speak with the nursing home’s administrator or business office manager first though. There are caps placed on outpatient therapy services and you will want to be sure your aging loved one hasn’t exceeded theirs already.

Nursing Home Alternatives

If you were counting on Medicare to help finance a senior loved one’s stay in a nursing home for “custodial care,” it usually causes families distress to discover this isn’t possible. The good news, however, is personal care (bathing and dressing) and support with the activities of daily living doesn’t have to be provided in a nursing home. Your family may have other options available to them.

An assisted living community or memory care community can both be solutions. In many areas of the country including in Dallas and Fort Worth, residential care homes offer yet another alternative for your family to explore. Each of these choices can help your senior loved one get the care and support they need at a price that is much less expensive than a nursing home.

If you need expert guidance finding an assisted living community or a residential care home for a senior loved one in the Dallas-Ft. Worth area, please call us at 214-929-5055 or complete our Contact Form. We will use our insider knowledge to help your family make an informed choice.

Senior Living Specialists is a free service for seniors and their families. We are compensated by a referral fee when a senior moves into a community or care home.