Depending on what kind of coverage you have, Medicare may pay for your health care and prescription drugs while you're in a nursing home.
You can get Medicare health care in 2 ways
- Original Medicare
Original Medicare doesn't pay for most nursing home care. Most nursing home care helps with activities of daily living. Medicare covers very limited and medically necessary skilled care or home health care if you need skilled care for an illness or injury and you meet certain conditions.
- Medicare Advantage Plans and other Medicare health plans
If you have a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan, check with your plan to see if it covers nursing home care. Usually, plans don't help pay for this care unless the nursing home has a contract with the plan. Ask the health plan about nursing home coverage before you make any arrangements. If the nursing home has a contract with your health plan, ask the health plan if they check the home for quality of care.
Medicare prescription drug coverage (Part D)
If you have a Medicare Prescription Drug Plan (Part D) and live in a nursing home or other institution, you'll get your covered prescriptions from a long-term care pharmacy that works with your plan. This long-term care pharmacy usually contracts with (or is owned and operated by) your institution.
Unless you choose a Medicare health plan with drug coverage or a stand-alone Medicare drug plan, Medicare automatically enrolls you into a Medicare drug plan if you have both Medicare and full Medicaid coverage and are living in an institution.
If you have Medicare & live in a nursing home or other institution, you should also know:
- If you move into or move out of a nursing home or other institution, you can switch Medicare drug plans at that time. You can switch Medicare drug plans at any time while you’re living in the institution.
- If you aren't able to join on your own, your authorized representative can enroll you in a plan that meets your needs.
- If you're in a skilled nursing facility (SNF) getting Medicare-covered skilled nursing care, your prescriptions generally will be covered by Part A.
Long-term care pharmacies contract with Medicare Prescription Drug Plans to provide drug coverage to their residents. If you're entering, living in, or leaving a nursing home, you'll have the opportunity to choose or switch your Medicare drug plan. This allows you to choose a plan that contracts with your nursing home's pharmacy.