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.
Nursing home care when you have Medicare
- If you have Original Medicare
Original Medicare doesn't pay for most nursing home care. Most nursing home care helps with activities of daily living like bathing, dressing, and using the bathroom. Medicare covers very limited and medically necessary skilled care at a nursing home or in your home (with home health care) if you need short-term skilled care for an illness or injury and you meet certain conditions. - If you have a Medicare Advantage Plan or other Medicare health plan
If you're in 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 your plan about nursing home coverage before you make any arrangements to enter a nursing home. 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 Medicare drug coverage (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.
If you have Medicare & live in a nursing home or other institution, you should know:
- Unless you choose a Medicare Advantage Plan with prescription drug coverage or a Medicare Prescription Drug Plan on your own, Medicare automatically enrolls people with both Medicare and full Medicaid coverage living in institutions into Medicare Prescription Drug Plans.
- If you move in or out of a nursing home or other institution, you can switch Medicare drug plans at that time. In this situation, “other institutions” do not include assisted living, adult living facilities, residential homes, or any kind of nursing home that’s not certified by Medicare or Medicaid.
- You can switch Medicare drug plans at any time while you’re living in the institution.
- If you aren't able to join a drug plan 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.
- If you live in a nursing home and have full Medicaid coverage, you pay nothing for your covered drugs after Medicaid has paid for your stay for at least one full calendar month.