Medicare does **not cover the rising cost of long-term nursing home care** for aging adults. While Medicare Part A provides some coverage for short-term skilled nursing care, this coverage is limited to a maximum of 100 days per benefit period and comes with strict eligibility requirements. After this period, Medicare stops paying, leaving patients and families responsible for the full cost of care.
To understand this better, it’s important to distinguish between two types of nursing home care:
– **Skilled nursing care**: This is medically necessary care provided by licensed professionals, often after a hospital stay, such as rehabilitation after surgery or stroke. Skilled nursing facilities (SNFs) offer this type of care.
– **Long-term custodial care**: This involves assistance with daily activities like bathing, dressing, and eating, usually provided by non-medical staff. Medicare does not cover this type of care.
Medicare Part A will cover skilled nursing care only if certain conditions are met:
– The patient must have had a qualifying hospital stay of at least three days as an inpatient (observation stays do not count).
– The care must be provided in a Medicare-certified skilled nursing facility.
– The care must be medically necessary and related to the hospital stay.
If these conditions are met, Medicare covers:
– **Days 1 to 20**: 100% of the approved costs.
– **Days 21 to 100**: Medicare covers most costs, but the patient pays a daily coinsurance fee (about $209.50 in 2025).
– **After day 100**: Medicare pays nothing; the patient is responsible for all costs.
If the patient needs care beyond 100 days, Medicare will not pay, and the cost can be substantial.
The cost of nursing home care is rising sharply. On average, nursing homes cost between $9,000 and $11,000 per month, but this varies widely by location and type of room. For example, a private room in New York can cost around $15,000 per month, while in Texas, it might be closer to $6,200. These costs are projected to continue increasing, with some estimates suggesting a 15-16% rise by 2030.
Medicare Advantage plans, which are alternatives to Original Medicare, must offer at least the same skilled nursing coverage but may have different rules, such as requiring in-network facilities or charging copayments even in the first 20 days. Benefits and costs vary widely
