Medicare Nursing Home Coverage

According to the most recent report by the Centers for Disease Control and Prevention, there are nearly 15,500 nursing homes in the U.S. Cumulatively, these facilities provided nearly 1.7 million licensed beds to our nation’s seniors and others who require medical care outside the home; servicing almost 1.4 million residents in total. 

As per the U.S. Department of Health and Human Services, the average cost for a semi-private room in a nursing care facility is close to $225 per day, $6,844 per month, and $82,128 per annum. And for a private room, you are expected to pay more. The cost roughly lies somewhere around $255 per day, $7,700 per month, and a total of $93,000 per annum.

The Question Is, How Much Of These Costs Will Medicare Cover?

Original Medicare and Nursing Home Benefits

The Centers for Medicare & Medicaid Services (CMS) state that if you have Original Medicare then a majority of your nursing home expenses will not be covered under it. While there will be some benefits under Part A (i.e. hospital insurance), they are extremely limited and usually applicable to “medically necessary” skilled nursing care due to an illness or any injury that meets the specific conditions. Even then, they are typically covered for only a limited period of time.

According to, Medicare does offer at least partial benefits toward the following:

– Medications

– Ambulance transportation (under certain circumstances)

– Meals and dietary counseling

– Medical supplies used while in the facility

– Physical or occupational therapy

– A semi-private room

– Skilled nursing care

Participants must have a qualifying hospital stay of three days, have some days left in their benefit period, and choose a facility that works with the Medicare program to be eligible for coverage related to the skilled nursing care expenses. The skilled nursing facility must be recommended by the doctor. This coverage is generally only applicable to patients with a hospital-related medical condition or a condition that developed while in a skilled nursing facility. 

Nursing Home Costs with Medicare

With the Original Medicare, your expected costs for skilled nursing home care largely depends on how long you need the care.

Here Is A Small Breakdown Of Costs As Provided By Medicare.Gov:

No. Of Days In The Skilled Nursing Facility

Your Costs Per Benefit Period

  1 – 20

$ 0

21 – 100

$167.50 coinsurance per day


All costs incurred

Medicare Advantage Nursing Home Benefits

If you have Medicare Advantage,Medicare Part C or any other type of Medicare-approved health insurance plan, then as per the CMS, the individual plan dictates whether any nursing home care coverage is provided and, if yes, then to what extent. However, the CMS also states that most of the plans will not contribute to such types of extended care unless a nursing home has a contract with a particular plan.

Medicare Prescription Drug Coverage and Nursing Home Care

According to the CMS, when you are in a skilled nursing facility which is approved by Medicare, then the prescription drug coverage is usually provided by Medicare Part A. Prescription drug costs incurred while living in a nursing home or any similar institution are also covered either by Medicare Part D or by Medicare Advantage plan at times, depending on which one you have.