What Happens When Medicare Stops Paying For Nursing Home Care?

What Happens When Medicare Stops Paying For Nursing Home Care - Who Pays For Nursing Home If You Have No Money

What happens when Medicare stops paying for nursing home care?

In this article you’ll learn: 

  • how long does Medicare pay for nursing home care
  • how long much does Medicare pay for long-term nursing home care?
  • what medicare covers in nursing home care
  • what is Medicare’s process to stop paying for nursing home costs
  • your options when Medicare stops paying for nursing home care
  • who pays for a nursing home if  you have no money
  • what can a nursing home take for payment
  • how to protect assets from nursing home costs

Let’s dig in.

Table of Contents

The Hive Law Has Been Featured In

Get A FREE Consultation!

We run out of free consultations every month. Sign up to make sure you get your free consultation. (Free $350 value.)

What Happens When Medicare Stops Paying For Nursing Home Care?

When Medicare stops paying for nursing home care, you’ll be responsible for the costs. 

Medicare coverage typically ends when skilled care is no longer needed. 

You may need to use other sources, like Medicaid or personal funds, to continue paying for the care. 

f Medicare stops paying for nursing home care, you may not get immediately kicked out of the facility. 

However, you will be responsible for covering the costs. 

The nursing home will likely work with you to explore other payment options, such as Medicaid or private funds. 

But if you can’t find a way to pay for the care, you may eventually need to find another arrangement or facility that fits your financial situation. 

It’s crucial to communicate with the nursing home administration to understand your options and avoid any sudden disruptions in care.

Read More: How To Protect Parents’ Assets From Nursing Homes

How Long Does Medicare Pay For Nursing Home Care?

Medicare pays for nursing home care for a limited time. 

It covers up to 100 days per benefit period. 

To qualify, you must have a qualifying hospital stay of at least three days and enter a Medicare-certified skilled nursing facility within 30 days of leaving the hospital. 

A qualifying hospital stay is when you are admitted to a hospital as an inpatient for at least three consecutive days. 

To be eligible for Medicare coverage of nursing home care, you must have this type of hospital stay before transitioning to a Medicare-certified skilled nursing facility.

After 100 days, you’ll be responsible for all costs. 

Medicare doesn’t pay for long-term nursing home care or custodial care. 

  • Long-Term Nursing Home Care: This is extended and ongoing residential care provided in a nursing home or skilled nursing facility. It is designed for individuals who require assistance with their daily living activities due to chronic illnesses, disabilities, or age-related conditions.
  • Custodial Care: This is a non-medical, long-term care service that helps individuals with their daily living activities, often provided in a nursing home or home care setting. These activities include assistance with bathing, dressing, eating, using the bathroom, and mobility. Custodial care does not involve skilled medical services but focuses on supporting individuals with their basic functional needs.

For these services, you may need to explore other options, such as Medicaid.

Read More: How To Avoid Nursing Home Taking Your House

How Much Does Medicare Pay For Long-Term Nursing Home Care?

As mentioned above, Medicare generally does not cover long-term nursing home care. 

It only covers short-term stays after a hospitalization, up to 100 days, with specific conditions. 

To be eligible for Medicare coverage of short-term nursing home care, the following conditions must be met:

  • You must have been admitted to a hospital for at least three days as an inpatient before going to the nursing home.
  • You need skilled nursing care or skilled rehabilitation services, which can only be provided by licensed professionals.
  • You must enter a Medicare-certified skilled nursing facility within 30 days of your hospital discharge.
  • Your doctor must certify that you need skilled care on a daily basis.
  • The care you need must be related to the same condition for which you were hospitalized.

If you meet these criteria, Medicare Part A may cover the first 20 days of care in full and a portion of the cost for days 21 to 100. 

However, after 100 days, Medicare coverage ends, and you will be responsible for all costs.

For long-term nursing home care, you may need to consider other options like Medicaid or private insurance. 

To qualify for Medicaid for long-term nursing home care, you must meet certain income and asset eligibility requirements. 

The specific criteria vary by state, but generally, you must have limited income and few assets.

The process typically involves the following steps:

  • Income and Asset Assessment: You need to disclose your financial information, including income, savings, property, and other assets.
  • Medicaid Spend-Down: If your income or assets exceed the Medicaid limits, you may be required to “spend down” your assets on medical expenses before becoming eligible.
  • Look-Back Period: Medicaid examines your financial transactions for the previous five years to check for any asset transfers made to qualify artificially.
  • Medical Necessity: You must also demonstrate that you require the level of care provided in a nursing home setting, as determined by a medical assessment.
  • Applying: You or a family member can apply for Medicaid for long-term care at your state’s Medicaid office or online through the official Medicaid website.

Read More: What Are The Disadvantages Of Putting Your House In A Trust?

Does Medicare Pay For Nursing Homes?

Medicare generally does not pay for long-term nursing home care. 

However, it may cover short stays for skilled nursing services after a hospitalization. 

To qualify, the person must have a qualifying hospital stay and need skilled care related to that condition. 

For long-term nursing home care, Medicaid is the program that provides coverage based on income and asset eligibility.

Read More: Can I Collect My Deceased Spouse’s Social Security And My Own At The Same Time?

What Medicare Covers In Nursing Home Care

Medicare covers skilled nursing care in a nursing home under specific conditions. 

Skilled nursing refers to professional medical care and services provided by licensed nurses in a nursing home or healthcare facility. 

These services are typically more specialized and intensive than basic caregiving. 

Skilled nursing care includes treatments like: 

  • wound dressings
  • injections
  • monitoring vital signs
  • administering medications
  • managing medical conditions

It includes services like nursing care, physical therapy, and occupational therapy. 

Medicare covers these services for a limited time after a qualifying hospital stay. 

However, it does not cover long-term custodial care in a nursing home, which is assistance with daily activities like bathing and eating. 

Read More: When A Husband Dies Does The Wife Get His Social Security Disability?

Duration Of Medicare Coverage For Nursing Home

Medicare covers nursing home care for a limited duration. 

It typically lasts up to 100 days per benefit period. 

To qualify, you need to have been admitted to a hospital for at least three days and require skilled nursing care. 

After the 100-day limit or if you no longer need skilled care, Medicare coverage ends. 

On the 101st day, Medicare’s coverage for nursing home care ends. 

If you continue to require skilled nursing care, you will be responsible for covering the full cost of your care unless you have other insurance or financial resources to assist you.

Read More: Low-Income Housing For Seniors Based On Income

Medicare’s Process To Stop Paying For Nursing Home Costs

Medicare stops paying for nursing home costs when a patient no longer needs skilled nursing care. 

They assess this by regular evaluations. 

If a patient’s condition improves or stabilizes, Medicare coverage may end. 

The patient may then be responsible for the costs or switch to other coverage like Medicaid or private insurance.

The Countdown To Day 101

Medicaid provides coverage for nursing home care, but it’s limited to certain circumstances and time frames. 

If you qualify, Medicaid pays for your first 100 days in a skilled nursing facility. 

You must enter the nursing home within 30 days of a hospital stay that lasted at least three days for the same condition.

Before the 100 days end, start planning for the next steps. 

Check if you’re eligible for Medicaid’s long-term care coverage

This coverage helps pay for nursing home care beyond 100 days. 

You might need to spend down your assets to qualify. 

It’s important to understand the rules because some assets, like a primary home, might not count towards your eligibility.

Another option is long-term care insurance

If you have a policy, it can help cover the costs. 

Check the terms of your insurance to understand what it covers and for how long.

If these aren’t viable options, you may need to pay for nursing home care out of pocket. 

Consider speaking with a financial advisor to understand how best to use your resources.

Also, consider other types of care like assisted living or home health care. 

They might be less expensive and could offer the level of care you need.

Read More: Who Needs A Trust Instead Of A Will?

Notification Of Non-Coverage

Medicare’s notification of non-coverage works like this:

  • Medicare evaluates the beneficiary’s condition and care needs regularly.
  • If the care no longer meets Medicare’s criteria, they issue a Notice of Medicare Non-Coverage (NOMNC).
  • The NOMNC explains the reasons for stopping payment and the beneficiary’s right to an expedited appeal.
  • The beneficiary has the right to continue receiving care during the appeal process.
  • To appeal, the beneficiary or their representative must request a Fast-Track appeal within two days of receiving the NOMNC.
  • The care will continue until a final decision is made through the appeal.
  • If the appeal is successful, Medicare continues to pay for the nursing home costs. If not, the beneficiary is responsible for the costs.

Read More: How To Get Power Of Attorney For Someone Who Is Incapacitated

Financial Implications

When Medicare stops paying for nursing home costs, it has financial implications for individuals. 

The process involves a determination by Medicare that skilled care is no longer necessary. 

After that, the individual becomes responsible for all nursing home expenses. 

This change can lead to significant financial burdens, as nursing home care can be expensive.

Your Options When Medicare Stops Paying For Nursing Home Care

When Medicare stops paying for nursing home care, you have several options:

  • Private Pay: You can continue to pay for the nursing home care out of your own funds.
  • Medicaid: If you meet certain income and asset requirements, you may qualify for Medicaid, which can cover nursing home costs.
  • Long-Term Care Insurance: If you have a long-term care insurance policy, it may cover the costs beyond Medicare coverage.
  • Veterans Benefits: If you’re a veteran or the spouse of a veteran, you might be eligible for VA benefits that could help cover nursing home expenses.

Let’s dig into each of those.

Read More: What Happens To An Irrevocable Trust When The Grantor Dies?

Paying Out-Of-Pocket

The cost of private pay for nursing home care can vary significantly depending on various factors, including 

  • the location of the nursing home
  • the level of care needed
  • the amenities provided
  • any additional services required

On average, nursing home care in the United States can range from $5,000 to $10,000 or more per month.

Long-Term Care Insurance

The cost of long-term care insurance for nursing home care can vary based on several factors, including 

  • the age at which you purchase the policy, 
  • the extent of coverage you choose,
  •  the waiting period before benefits kick in
  • any optional riders you add to the policy.

On average, the annual premium for long-term care insurance can range from a few hundred to a few thousand dollars. 

Read More: Does A Revocable Trust Become Irrevocable Upon Death


Medicaid is a government program that provides financial assistance to individuals who have limited income and assets and need nursing home care. 

The cost of Medicaid for nursing home care is generally based on your income and assets, as well as the state you live in.

This is because Medicaid is a joint federal and state program with varying eligibility criteria and benefits.

When it comes to nursing home care, Medicaid typically covers the costs for eligible individuals who meet the specific income and asset requirements set by their state’s Medicaid program. 

In most cases, Medicaid will cover the full cost of nursing home care for those who qualify.

To qualify for Medicaid, you must meet certain eligibility requirements, which can vary by state due to Medicaid being a joint federal and state program. 

However, there are some common criteria that generally apply:

  • Income: Your income must be below a certain threshold, which varies by state and household size. Some states have expanded Medicaid to cover individuals with higher income levels under the Affordable Care Act (ACA).
  • Assets: You must have limited assets or resources. Certain assets, such as your primary residence, may be exempt from consideration.
  • Citizenship or Legal Residency: You must be a U.S. citizen or a qualified non-citizen with appropriate immigration status.
  • State Residency: You must be a resident of the state where you are applying for Medicaid.
  • Category of Eligibility: Medicaid provides coverage for different groups, including low-income adults, children, pregnant women, seniors, and people with disabilities. You must fall into one of these eligible categories.
  • Other Requirements: Some states have additional requirements, such as work requirements (for non-disabled adults) or specific health conditions.

To apply for Medicaid, you need to complete an application through your state’s Medicaid agency or the Health Insurance Marketplace if your state uses the Marketplace for Medicaid enrollment. 

It’s essential to gather the necessary documentation, such as proof of income, assets, citizenship, and residency, to support your application.

Read More: How To Set Up A Trust Fund For A Child

Veterans' Benefits

The Department of Veterans Affairs (VA) provides a variety of benefits and programs to assist veterans with nursing home care. 

The amount of veterans benefits for nursing home care can vary depending on the specific program and the individual’s eligibility status.

  • VA Community Living Centers (CLCs): Veterans who qualify for VA healthcare and require nursing home level of care may be eligible for placement in a VA Community Living Center. The cost of care in a VA CLC is based on the veteran’s VA healthcare eligibility and financial situation. Some veterans may receive care at little to no cost, while others may have a co-payment requirement based on their income.
  • State Veterans Homes: State Veterans Homes are facilities that provide nursing home care to veterans. The cost of care in State Veterans Homes can vary by state and is typically based on the veteran’s income and assets. Eligible veterans may receive financial assistance from the VA to help cover the costs.
  • Aid and Attendance (A&A) and Housebound Benefits: These are additional benefits that can be provided to veterans who are eligible for a VA pension and require the aid and attendance of another person or are housebound due to their disabilities. The amount of A&A and Housebound benefits can be added to the veteran’s basic pension rate, increasing the overall pension amount.

Read More: Does Your House Have To Be Paid Off To Put It In A Trust

Who Pays For Nursing Home If You Have No Money?

If you have no money and can’t afford a nursing home, Medicaid may cover the costs. 

Medicaid is a government program that helps low-income individuals with medical expenses, including nursing home care. 

To qualify for Medicaid, you must meet specific income and asset requirements. 

Read More: How Can I Pay For Assisted Living With No Money?

How To Pay For A Nursing Home With No Money

To pay for a nursing home with no money:

  • Medicaid: Apply for Medicaid, a government program that covers nursing home costs for low-income individuals.
  • Asset Planning: Consult with an elder law attorney to legally transfer assets or restructure finances to meet Medicaid eligibility requirements.
  • Medicaid Waiver Programs: Explore Medicaid waiver programs that offer assistance for home or community-based care instead of a nursing home.
  • Veterans Benefits: Veterans or their spouses may qualify for Aid and Attendance Pension Benefit for nursing home expenses.
  • Long-Term Care Insurance: Check if any long-term care insurance policy covers nursing home costs.
  • Charitable Assistance: Some charitable organizations offer financial help for nursing home care.
  • Reverse Mortgage: Consider a reverse mortgage on the home to fund nursing home expenses.
  • Selling Assets: Sell non-essential assets like a second home or vehicle to pay for nursing home care.
  • Payment Plans: Negotiate payment plans with the nursing home to manage costs.

Read More: How Much Do Trusts Cost?

How To Pay For Nursing Home Care With Social Security

To pay for nursing home care with Social Security:

  • Determine Eligibility: Check if the person qualifies for Social Security benefits and if they meet the nursing home’s requirements.
  • Apply for Benefits: Submit a Social Security application online, by phone, or at a local office.
  • Calculate Benefit Amount: Find out the monthly benefit amount based on the person’s work history and age.
  • Review Nursing Home Costs: Research and compare nursing home facilities to understand the expenses.
  • Combine Income Sources: Consider other income sources like pensions or savings to cover the remaining cost after Social Security benefits.
  • Medicaid Assistance: Explore Medicaid if Social Security benefits alone can’t cover the nursing home expenses.
  • Communicate With The Nursing Home: Inform them of the payment arrangement using Social Security benefits.
  • Continually Review Finances: Regularly assess the financial situation and adjust as needed.

What Can A Nursing Home Take For Payment?

A nursing home can take payment for the care and services they provide to residents. 

This payment typically comes from various sources, including private funds, long-term care insurance, or government programs like Medicaid. 

Nursing homes may also require residents to sign an agreement outlining the payment terms before admission. 

In some cases, a nursing home may work with residents to determine a payment plan based on their financial situation. 

Read More: What Happens To A House In A Trust After Death?

Protecting Assets From Nursing Home Costs

You should consider protecting various types of assets from nursing home costs, including:

  • Personal Savings: Cash, bank accounts, and investments.
  • Real Estate: Primary residence and other properties.
  • Retirement Accounts: 401(k)s, IRAs, and pensions.
  • Life Insurance Policies: Cash value or whole life insurance policies.
  • Business Interests: Ownership stakes in businesses.
  • Gifts to Family: Assets transferred as gifts to family members.

Here are some ways of protecting assets from nursing home costs:

  • Plan in Advance: Start planning early to safeguard assets.
  • Medicaid Trust: Consider setting up a Medicaid trust to shield assets from nursing home expenses.
  • Irrevocable Trust: Create an irrevocable trust to transfer assets and maintain eligibility for Medicaid.
  • Gifting: Gift assets to family members, but be aware of Medicaid’s look-back period.
  • Long-Term Care Insurance: Obtain long-term care insurance to cover nursing home expenses.
  • Spousal Protections: Ensure the healthy spouse retains a sufficient share of assets.
  • Annuities: Use annuities to convert assets into income, potentially qualifying for Medicaid.
  • Homestead Exemption: Utilize homestead exemptions to protect the primary residence.

FAQs About What Happens When Medicare Stops Paying For Nursing Home Care

Here are other questions our clients ask us about what happens when Medicare stops paying for nursing home costs. 

Does A Irrevocable Trust Protect Assets From Nursing Homes?

Yes, an irrevocable trust can protect assets from nursing home costs. 

When assets are transferred into the trust, they are no longer considered the property of the individual. 

As a result, they may not be used to pay for nursing home expenses. 

However, the trust must be created and funded before nursing home care is needed to be effective.

Read More: Does Putting Your Home In A Trust Protect It From Medicaid?

Does Medicare Cover Nursing Home Care For Dementia?

Yes, Medicare covers nursing home care for dementia.

It pays for skilled nursing facility (SNF) care if certain criteria are met.

Coverage includes up to 100 days per benefit period.

Medicare will cover the costs if the person needs skilled nursing care.

It does not cover long-term custodial care for dementia in a nursing home.

Does Medicare Part B Pay For Nursing Homes?

No, Medicare Part B does not pay for nursing home care. 

Medicare Part B primarily covers outpatient services and medical supplies. 

For nursing home care, Medicare Part A may provide limited coverage under certain conditions, but it’s not comprehensive. 

Medicaid is the program that typically covers nursing home expenses for eligible individuals with limited income and assets.

Does Medicare Pay For Nursing Home Care For The Elderly?

Yes, Medicare does pay for nursing home care for the elderly in certain situations. 

Medicare Part A covers a portion of skilled nursing facility care after a qualifying hospital stay. 

The coverage includes a semi-private room, meals, skilled nursing care, and therapy services. 

However, it’s essential to note that Medicare coverage for nursing home care has specific eligibility criteria and limitations. 

It won’t cover long-term custodial care for extended periods.

Get Help With Nursing Home Planning

If you want help planning for nursing home costs, fill out the form below. 

At The Hive Law, we understand the importance of:

  • protecting your hard-earned assets 
  • ensuring your family’s future
  • not losing everything to creditors and lawsuits
  • properly (and legally) distributing assets 

We only accommodate a limited number of clients each month.

So don’t miss your opportunity to work with our estate planning lawyers.

Benefits of our trust services:

  • Tailored solutions to fit your unique needs and goals
  • Expert guidance in navigating complex tax and legal matters
  • Preservation of your wealth for future generations
  • Streamlined asset distribution according to your wishes

Avoid the pitfalls of inadequate estate planning strategies:

  • Creditors seizing your assets
  • Lawsuits jeopardizing your family’s financial security
  • Family disputes over inheritance
  • Costly and time-consuming probate processes

Talk soon.

Get A FREE Consultation!

We run out of free consultations every month. Sign up to make sure you get your free consultation. (Free $350 value.)

Share This Post With Someone Who Needs To See It