Medicare Part B does not pay for custodial nursing home care

Medicare Part B covers doctor visits, outpatient services, and some medical equipment — but it does not cover the room, board, or daily custodial care you receive in a nursing home. If you move to a nursing home mainly because you need help with activities like bathing, dressing, eating, or taking medication, Part B will not pay for your stay.

What Part B will cover in a nursing home setting is limited and specific: doctor visits while you are there, certain therapies ordered by your doctor, lab work, X-rays, and some medical supplies. The key difference is that Part B pays for medical treatment, not for the place itself or the personal care staff.

If you need skilled nursing care — meaning care that requires a licensed nurse or therapist — for a short recovery period after a hospital stay, that is different. Medicare Part A (hospital insurance) covers the first 100 days of skilled nursing facility care after a may have access to hospital stay of at least three days. Part B does not replace Part A in this situation.

Key Takeaways

  • Medicare Part B does not pay for room, board, or custodial care in a nursing home, even if you live there full-time.
  • Part B does cover doctor visits, certain therapies, lab work, and medical supplies while you are in a nursing home.
  • If you need skilled nursing care after a hospital stay, Medicare Part A (not Part B) covers up to 100 days in a skilled nursing facility.
  • Long-term nursing home costs are typically covered by Medicaid, private pay, long-term care insurance, or a combination of these.

What Part B covers inside a nursing home

Your Part B benefits work the same way in a nursing home as they do anywhere else. If your doctor orders a visit to check on your heart condition, manage your diabetes, or monitor your recovery, Part B covers that doctor's time and informed. You pay your usual Part B copay (typically 20 percent of the approved amount after you meet your annual deductible).

Physical therapy, occupational therapy, and speech therapy ordered by your doctor are also covered by Part B if they are medically necessary — for example, therapy to regain strength after a stroke or to relearn swallowing after surgery. These services must be provided by a licensed therapist and ordered as part of a medical treatment plan.

Lab tests, blood work, X-rays, and imaging ordered by your doctor are covered under Part B. Certain medical equipment and supplies — such as oxygen, diabetic testing supplies, or a walker — may also be covered if your doctor prescribes them and they meet Medicare's criteria.

What Part B does not cover in a nursing home

Part B does not pay for the nursing home bed itself, meals, housekeeping, laundry, or the staff who help you bathe, dress, eat, or use the toilet. These are considered custodial care — information with daily living activities — and they are not medical services. Even if a nurse or aide provides this help, the cost of that person's time and the room you occupy are not Part B expenses.

Medications given to you in the nursing home are covered under Medicare Part D (prescription drug coverage) if you have it, not Part B. Part B does not cover the cost of most prescription drugs.

Nursing home services that are not ordered by a doctor or not medically necessary are also not covered. For example, if you move to a nursing home for social reasons or because you live alone and want company, Part B will not pay for your stay.

When Medicare Part A covers nursing home care instead

If you spent at least three consecutive days in a hospital and your doctor determines you need skilled nursing care to continue your recovery, Medicare Part A will cover a skilled nursing facility (SNF) for up to 100 days. This is different from long-term custodial care in a nursing home.

Part A covers all costs for the first 20 days with no copay. From day 21 through day 100, you pay a daily copay (the amount changes each year; in 2024 it is $200 per day). After 100 days, you pay all costs yourself unless you have other coverage like Medicaid or a private long-term care insurance policy.

This Part A coverage ends when your doctor determines you no longer need skilled care, even if you are still in the nursing home. At that point, if you stay, you become responsible for all costs unless Medicaid or another payer takes over.

How long-term nursing home stays are actually paid for

Medicaid is the largest payer of long-term nursing home care in the United States. If your income and assets fall below your state's limits, Medicaid may cover your nursing home costs. Each state sets its own income and asset limits, so what qualifies in one state may not in another. You must explore through your state Medicaid office.

Private pay means you or your family pay out of pocket. Nursing home costs vary widely by location and level of care, but can range from several thousand to over ten thousand dollars per month.

Long-term care insurance is a separate insurance product you purchase before you need care. It covers nursing home costs and in-home care if you meet the policy's definition of needing care. Not everyone has this coverage, and premiums can be expensive.

Some people use a combination: Medicare Part A for the first 100 days after a hospital stay, then Medicaid for ongoing care if they may have access to, or private pay if they have the resources.

Understanding the difference between skilled and custodial care

Skilled care requires a licensed nurse or therapist to provide or supervise treatment. Examples include wound care after surgery, physical therapy to regain mobility, or monitoring of complex medications. Skilled care is time-limited — it is meant to help you recover or stabilize, not to provide permanent information.

Custodial care is help with daily living activities that do not require a medical license. Bathing, dressing, eating, toileting, and medication reminders are custodial care. Many nursing homes provide custodial care, and some residents need both skilled and custodial care at the same time.

Medicare Part A covers skilled care for a limited time after a hospital stay. Medicare Part B does not cover custodial care at all. This distinction matters because it determines what Medicare will pay for and what you or another payer must cover.

Planning ahead for nursing home costs

If you think you may need nursing home care in the future, understanding what Medicare does and does not cover can help you plan. Part B will not cover your stay, so you need to know about other options: Medicaid, private pay, long-term care insurance, or family support.

Talk to your doctor about your health and what kind of care you might need. Ask your family about their expectations and resources. Look into your state's Medicaid rules and asset limits if you think you might may have access to. If you have the means, consider long-term care insurance while you are still healthy enough to purchase it.

Your local Area Agency on Aging can provide information about nursing homes in your area, costs, and payment options. You can find your local agency through the Eldercare Locator at 1-800-677-1116.

Frequently Asked Questions

If I have a Medicare Advantage plan instead of Original Medicare, does it cover nursing home care?

Medicare Advantage plans (Part C) must cover at least what Original Medicare covers, so they also do not cover custodial nursing home care. Some Advantage plans offer extra benefits like limited skilled nursing facility stays or in-home care, but these vary by plan. Check your plan's summary of benefits or call the plan directly to ask what nursing home services are covered.

Will Part B pay for my doctor to visit me in the nursing home?

Yes. Your doctor's visit is covered under Part B just as it would be in an office or hospital. You pay your usual copay. The nursing home itself is not covered, but the medical care you receive there is.

What happens if I need nursing home care but do not may have access to for Medicaid?

If you do not may have access to for Medicaid and do not have long-term care insurance, you would need to pay privately for nursing home care. Some people use savings, sell assets, or receive help from family. Some nursing homes offer payment plans or sliding scale fees based on income. It is worth asking the nursing home about their options.

Can I use my Medicare savings account to pay for nursing home care?

A Medicare Savings Account (MSA) is a type of Medicare Advantage plan that lets you save unused benefits. However, it still does not cover custodial nursing home care — only the medical services Part B would cover. If you have a traditional Health Savings Account (HSA) from your employer, you may be able to use those funds for nursing home costs, but rules vary. Speak with your tax advisor or HSA administrator.

If I move to a nursing home after a hospital stay, how long does Part A coverage last?

Part A covers up to 100 days in a skilled nursing facility after a may have access to three-day hospital stay. Coverage ends when your doctor says you no longer need skilled care, even if you stay in the nursing home. After that, you pay out of pocket unless Medicaid or another payer covers you.