Health care & prescriptions in a nursing home

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.

Medicare covers nursing home care in 2 ways:

  1. 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 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.
  2. Medicare Advantage Plans and other Medicare health plans
    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 prescription 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.

Learn more about your drug coverage if you have full coverage from Medicaid and live in a nursing home.

If you have Medicare & live in a nursing home or other institution, you should know:

  • If you move in or 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 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.