Medicare Part B does not pay for custodial nursing home care

Medicare Part B covers doctor visits, outpatient services, and 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 bathing, dressing, eating, or toileting, Part B will not pay for your stay.

What Part B will cover in a nursing home is specific medical services: a doctor's visit to your room, physical therapy ordered by your doctor, lab work, X-rays, or certain medications given as part of a treatment plan. But these are add-ons to your care, not payment for the nursing home itself.

The distinction matters because it shapes how you pay. You cover the nursing home bill (which can run $100 to $300 per day or more, depending on your location and the facility) through savings, Medicaid, long-term care insurance, or family help. Part B covers only the medical services layered on top.

Key Takeaways

  • Medicare Part B does not pay for room, board, or custodial care in a nursing home, only for specific medical services like doctor visits or therapy ordered by your doctor.
  • Medicaid, not Medicare, is the program that typically pays for long-term nursing home stays once you meet income and asset limits.
  • Medicare Part A covers a limited stay in a skilled nursing facility (up to 100 days) if you were hospitalized first and need rehabilitation, which is different from a custodial nursing home.
  • You remain responsible for the full nursing home bill unless you have Medicaid, long-term care insurance, or other coverage.
  • Medical services you receive in the nursing home — such as wound care, injections, or therapy — may be covered by Part B or Part A depending on your situation.

The difference between skilled nursing and custodial care

A skilled nursing facility (SNF) is not the same as a custodial nursing home, and Medicare treats them differently. A skilled nursing facility provides rehabilitation or medical care after a hospital stay — for example, physical therapy after a hip replacement or wound care after surgery. Medicare Part A covers up to 100 days in a skilled nursing facility if you were hospitalized for at least three days first.

A custodial nursing home, by contrast, is where you live when you need ongoing help with daily activities but do not need skilled medical care. Many facilities offer both levels of care, but the payment source changes depending on which level you are in. If you move from the skilled wing to the custodial wing, your coverage switches from Part A to Medicaid (if you may have access to) or out of pocket.

Part B does not distinguish between the two — it covers medical services in either setting, but only those services, not the room or the help with daily living.

What Part B covers inside a nursing home

When you are in a nursing home, Part B pays for doctor visits to your room, just as it would in your home. Your doctor can visit you there, and Part B covers the visit at the standard rate. You pay your Part B coinsurance (usually 20 percent of the approved amount) after you meet your deductible.

Part B also covers outpatient services ordered by your doctor while you live in the nursing home. This includes physical therapy, occupational therapy, and speech therapy — but only if your doctor orders it as part of a treatment plan for a specific condition. Therapy aimed at general wellness or maintenance does not may have access to. Lab work, X-rays, and other diagnostic tests ordered by your doctor are covered the same way they would be outside the nursing home.

Durable medical equipment — a walker, wheelchair, oxygen, or hospital bed — may be covered by Part B if your doctor prescribes it. The nursing home may provide some equipment as part of your room charge, but if you need specialized equipment, Part B can help pay for it.

Medications given to you in the nursing home are covered differently depending on how they are delivered. If a nurse injects or infuses a medication as part of your medical treatment, Part B may cover it. Oral medications you take yourself are typically covered by Part D (prescription drug coverage) if you have it, not Part B.

Medicaid is the program that pays for long-term nursing home care

Medicaid, not Medicare, is the primary payer for long-term nursing home stays. Medicaid is a joint federal and state program for people with low income and limited assets. Each state sets its own income and asset limits, so the threshold for Medicaid coverage varies by where you live.

If you are in a nursing home and your income and assets fall below your state's limits, you can explore for Medicaid to cover your room, board, and custodial care. Medicaid pays the nursing home directly, and you typically contribute any income you have toward the bill (keeping a small personal needs allowance). The nursing home bills Medicaid for the rest.

Many people enter a nursing home using their own savings and then explore for Medicaid once their assets drop below the limit. This is legal, but the process and timing vary by state. Some states have a "look-back" period — they review your finances for a set number of months before you applied to see if you gave away assets to become may be able to access faster. If you did, Medicaid may delay your coverage.

If you think you may need nursing home care in the future, speaking with an elder law attorney or a Medicaid planner about your options now can help you understand your state's rules and plan accordingly.

Medicare Part A and skilled nursing facility coverage

If you are admitted to a hospital and then need rehabilitation in a skilled nursing facility, Medicare Part A covers your stay — not Part B. Part A covers up to 100 days per benefit period in a skilled nursing facility, but only if you meet specific conditions: you must have been hospitalized for at least three consecutive days, you must be admitted to the skilled nursing facility within 30 days of leaving the hospital, and your doctor must order skilled care (not just custodial care).

For the first 20 days, Part A covers the full cost of the skilled nursing facility. From day 21 to day 100, you pay a coinsurance amount (in 2024, this is $200 per day, though the amount changes yearly). After 100 days in a benefit period, you pay the full cost yourself unless you have other coverage.

This is temporary rehabilitation coverage, not long-term care. Once you no longer need skilled care — once your therapy is complete or your condition has stabilized — Part A stops paying, and you must find another way to cover your stay if you remain in the facility.

Long-term care insurance and other payment sources

Some people have long-term care insurance, a separate policy purchased years before they need nursing home care. This insurance pays a daily benefit toward nursing home costs once you meet the policy's requirements (usually a waiting period and proof that you cannot perform certain daily activities). Long-term care insurance is not part of Medicare; it is a private product sold by insurance companies.

If you have long-term care insurance, check your policy to see what it covers, what the daily benefit is, and whether it applies to the nursing home you are considering. Some policies cover only skilled nursing facilities, while others cover custodial care as well. The nursing home's billing department can often help you understand how your policy works with their charges.

Veterans may have coverage through the Department of Veterans Affairs, and some people have coverage through their former employer's retiree health plan. If you are unsure what coverage you have, contact your insurance company or your state's health insurance counselor (available free through your state's Health Insurance information Program, or SHIP).

Planning ahead: what to do now

If you are thinking about nursing home care in the future, understanding what Medicare does and does not cover helps you plan. Start by reviewing your current coverage: Do you have Part A and Part B? Do you have Part D for prescriptions? Do you have a Medigap or Medicare Advantage plan? Do you have long-term care insurance?

Next, understand your state's Medicaid rules. Your state's Medicaid office or an elder law attorney can tell you the income and asset limits, the look-back period, and how to plan if you think you will need Medicaid eventually. Some people use this information to structure their finances or purchase long-term care insurance while they are still healthy and insurable.

Finally, talk to your family about your wishes and your finances. Nursing home care is expensive, and the conversation is easier to have before a crisis forces the decision. Your doctor, a social worker, or an elder law attorney can help guide these conversations.

Frequently Asked Questions

Will Medicare pay for my nursing home if I need it after a hospital stay?

Medicare Part A will pay for up to 100 days in a skilled nursing facility if you were hospitalized first and need rehabilitation. After that, or if you need custodial care rather than skilled care, you must use Medicaid, savings, insurance, or family help. Part B does not pay for the nursing home itself, only for medical services like doctor visits.

What happens when my 100 days of Medicare coverage in a skilled nursing facility runs out?

Once Part A coverage ends, you are responsible for the full cost of the nursing home unless you have Medicaid, long-term care insurance, or other coverage. If you meet your state's Medicaid income and asset limits, you can explore for Medicaid to take over payment. Otherwise, you pay out of pocket or arrange other funding.

Can I use my Medicare Advantage plan to pay for a nursing home?

Medicare Advantage plans follow the same rules as Original Medicare — they do not cover custodial nursing home care. Some Medicare Advantage plans offer supplemental benefits like adult day care or in-home support, but these are not the same as nursing home coverage. Check your plan's summary of benefits to see what it includes.

Do I have to spend down my savings before Medicaid will pay for a nursing home?

Yes, in most states you must spend your assets down to the Medicaid limit (usually a few thousand dollars) before Medicaid will cover your nursing home care. The exact limit and the process vary by state. An elder law attorney can explain your state's rules and help you plan.

If I move to a nursing home, will my Part B premiums and costs change?

Your Part B premiums stay the same whether you live at home or in a nursing home. You continue to pay your monthly premium, and you still owe coinsurance for medical services like doctor visits. Your Part B coverage does not change based on where you live.