Medicare generally does not cover long-term custodial nursing home care. Help with everyday activities is different from qualifying skilled nursing facility care after illness or injury. A facility's name alone does not establish coverage.
Ask what level of care is proposed
Medicare may cover a limited skilled nursing facility stay when its requirements are met. That is not an automatic promise of a fixed number of covered days. Coverage depends on ongoing eligibility and the applicable rules; Medicare Advantage arrangements can differ.
Before admission
| Question | Who can help |
|---|---|
| What care do I need? | Clinical team and discharge planner |
| Do coverage requirements apply to this stay? | Medicare or the plan |
| What will I pay? | Plan and facility billing office |
| What happens if coverage ends? | Facility, care team and assistance office |
Plan for longer-term needs
Ask for a written explanation of charges and which services are included. Medicaid may help eligible people with long-term care under state rules; it is not automatic merely because Medicare stops paying. Discuss financial and care planning with appropriate qualified professionals.
Keep notices about coverage ending and read the review instructions promptly. Also compare quality, accessibility, family access and the services the facility can actually provide. Insurance coverage is one part of choosing an appropriate care setting.
Continue with a related question
- Medicare Home Health Care: What to Verify
- Medicare and Medicaid: Different Programs, Coordinated Help
- A Medicare Medical Claim Was Denied: What to Do Next