What Humana actually pays for in a nursing home

Humana does not pay for long-term nursing home care the way Medicare does. The length of coverage depends entirely on which Humana plan you have — Medicare Advantage, Medicaid, or a standalone long-term care insurance policy. Each one has different limits, and most people are surprised to learn that Medicare Advantage plans (the most common Humana product for seniors) cover only short-term skilled nursing stays, not permanent placement.

If you have a Humana Medicare Advantage plan, coverage typically lasts up to 100 days per benefit period after a may have access to hospital stay of at least three days. After those 100 days, you pay the full cost yourself unless you also have Medicaid or a separate long-term care policy. If you have Humana Medicaid, coverage can extend much longer — sometimes indefinitely — but only if you meet your state's income and asset limits, which vary widely.

The confusion happens because "nursing home" covers two different things: skilled nursing (short-term rehabilitation after surgery or illness) and custodial care (long-term help with daily living). Humana insurance almost never pays for custodial care unless you have Medicaid or a long-term care policy.

Key Takeaways

  • Humana Medicare Advantage plans cover up to 100 days of skilled nursing per benefit period, but only after a hospital stay of at least three days.
  • After 100 days, you pay the full nursing home bill yourself unless you have Medicaid or a separate long-term care insurance policy.
  • Humana Medicaid covers longer stays, but only if you meet your state's income and asset limits, which change by state.
  • You must ask Humana in writing whether your specific stay qualifies as skilled nursing before admission, because the information affects how many days are covered.
  • If you run out of Humana coverage, Medicaid may take over if you spend down to your state's asset limit, but the process takes weeks.

How the 100-day limit works on a Medicare Advantage plan

If you have a Humana Medicare Advantage plan and are admitted to a nursing home for skilled care after a hospital stay, Humana covers the first 20 days in full. Days 21 through 100 require a daily copay, which varies by plan but is often $200 to $300 per day. You pay this copay out of pocket; Humana covers the rest of the bill.

The clock resets each benefit period (calendar year), so if you use 60 days in January, you have 40 days left for the rest of that year. On January 1 of the next year, you get a fresh 100 days. This matters if you are discharged and readmitted — a new hospital stay that lasts three days or more starts a new count.

The three-day hospital stay requirement is strict. If you go to the emergency room, get admitted to the hospital, and are discharged directly to a nursing home without spending three full days as an inpatient, Medicare Advantage will not cover the nursing home stay at all. Some people spend two days in the hospital and think they may have access to; they do not. Ask the hospital to confirm in writing that you have met the three-day requirement before you are discharged.

Humana Medicaid nursing home coverage

Humana Medicaid plans cover nursing home care for as long as you need it, with no day limit. However, you must meet your state's Medicaid income and asset limits to stay on the plan. These limits vary: some states allow you to keep $2,000 in assets, others allow more. Some states count your home and car as assets; others do not.

If you are already on Humana Medicaid when you enter a nursing home, coverage begins when ready. The nursing home will work with Humana to confirm you are still may be able to access. If your income or assets exceed the limit, you may lose Medicaid coverage and have to pay out of pocket until you spend down to the limit again — a process that can take months.

If you are not on Medicaid when you enter a nursing home, you can explore while you are there. The process takes 30 to 45 days in most states. During that time, you pay the full nursing home bill. Once Medicaid approves you, it covers the stay retroactively to the date you applied, so the nursing home can bill Medicaid for those weeks you paid out of pocket.

Long-term care insurance through Humana

Humana also sells standalone long-term care insurance policies, separate from Medicare or Medicaid. These policies pay a daily benefit (often $100 to $300 per day) for nursing home care, assisted living, or home care, for as long as your policy specifies — sometimes three years, sometimes five years, sometimes lifetime.

The length of coverage depends on what you bought when you enrolled. If your policy says it covers three years of nursing home care, Humana will pay the daily benefit for up to three years. After that, you pay out of pocket. The daily benefit does not cover the full cost of most nursing homes, so you typically pay the difference yourself.

Long-term care policies have a waiting period (called the elimination period), usually 30, 60, or 90 days. Humana does not pay anything during this time; you pay the full nursing home bill. Once the waiting period ends, Humana begins paying the daily benefit for the remaining length of the policy.

What happens when Humana coverage runs out

When your 100 days end on a Medicare Advantage plan, or when your long-term care policy benefit period expires, you become responsible for the full nursing home bill. This is often $8,000 to $12,000 per month, depending on your location and the facility's level of care.

At this point, your options are limited. You can pay out of pocket if you have savings. You can explore for Medicaid if you have not already; once approved, Medicaid covers the nursing home bill for as long as you need care. You can ask the nursing home about a payment plan or financial information program, though few facilities offer these. You can also ask about transferring to a facility that accepts Medicaid patients, which may be different from your current home.

Many people spend down their savings to reach Medicaid's asset limit, then explore. This is legal, but it takes time — you may spend $20,000 to $30,000 of your own money before Medicaid takes over. Talk to a Medicaid caseworker or elder law attorney before you start spending down, because some moves (like giving money to family) can delay Medicaid approval.

How to find out your actual coverage before admission

Do not assume you know what Humana will cover. Call Humana directly and ask them to review your specific situation in writing. Tell them the name of the nursing home, the reason for admission (surgery recovery, stroke rehabilitation, etc.), and ask them to confirm: how many days are covered, what your copay will be, and whether the stay qualifies as skilled nursing.

Ask Humana to send you a letter with this information. Do not rely on a phone call or what the nursing home tells you — the nursing home may not have current information about your plan. If Humana says the stay does not may have access to, ask them what would make it may have access to, or ask for the specific policy language that explains the denial.

If you are already in the nursing home and Humana denies coverage, you have the right to appeal. Ask Humana for the appeal process in writing. You can also contact your state's health insurance counselor (usually through your Area Agency on Aging) for help understanding the denial.

Questions to ask Humana before you need a nursing home

If you are on a Humana Medicare Advantage plan, ask these questions now, while you are healthy:

  • How many days of skilled nursing care does my plan cover per benefit period?
  • What is my copay for days 21 through 100?
  • Does my plan cover rehabilitation at home instead of a nursing home, and for how long?
  • If I am admitted to a nursing home without a three-day hospital stay, what happens?
  • What do I need to do to appeal a coverage denial?

Write down the answers and keep them with your insurance card. If you are on Medicaid, ask your caseworker the same questions, plus: what are my state's income and asset limits, and what happens if I exceed them while in a nursing home?

Frequently Asked Questions

Does Humana cover nursing home care after a fall at home?

Only if the fall leads to a hospital stay of at least three days. If you fall, go to the emergency room, get treated, and are sent home the same day, Humana will not cover a nursing home stay. If you are admitted to the hospital for three days or more (for example, for surgery to repair a broken hip), then Humana covers up to 100 days of skilled nursing rehabilitation.

What if I need a nursing home but do not have three days in the hospital?

Humana Medicare Advantage will not cover the stay. You pay out of pocket, or you explore for Medicaid if you meet the income and asset limits. Some people ask their doctor if they can be admitted to the hospital for observation to meet the three-day requirement, but hospitals cannot admit you just to satisfy insurance rules — the admission must be medically necessary.

Can Humana Medicaid cover a nursing home forever?

Yes, as long as you remain may be able to access for Medicaid. If your income or assets exceed your state's limit, you lose coverage until you spend down again. If you are in a nursing home and your income is too high, ask the nursing home social worker about a Medicaid spend-down plan or a special needs trust, which may allow you to keep more assets while staying on Medicaid.

If I have both Medicare Advantage and Medicaid, which one pays first?

Medicare Advantage pays first for the first 100 days. After that, Medicaid takes over and covers the nursing home for as long as you need care. Make sure both Humana and your Medicaid program know you have both plans, so there is no confusion about who pays.

What if the nursing home costs more than Humana pays?

You pay the difference. If Humana covers $200 per day and the nursing home charges $300 per day, you owe $100 per day out of pocket. Ask the nursing home for an itemized bill and ask Humana exactly what they are paying, so you understand what you owe.