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Are all of your needs covered with Original Medicare? Let’s find out.
SelectQuote’s licensed insurance agents can help you understand Medicare Advantage plan coverage options. It’s free and there’s no obligation to enroll.
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Original Medicare Long-Term Care Coverage and Hospice Needs
Does Original Medicare cover long-term care needs?
Generally, the answer is no. When you live in a nursing home, you’re likely there for an indefinite stay, requiring daily non-medical assistance such as bathing, grooming, and medication monitoring. These are services that Original Medicare does not cover.Although Original Medicare does not pay for an indefinite stay, Medicare Part A and Medicare Part B are still important to have to help cover expenses associated with hospital care, doctor services, and medical supplies. Original Medicare also offers some coverage should you need short-term, medically necessary nursing care; for example, if you’ve been discharged from the hospital following heart surgery or hip replacement. This care could be done in a skilled nursing facility (SNF) or it could be done in a nursing home.
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Medicare Nursing Home Care
Both Original Medicare and a Medicare Advantage plan approach nursing home expenses a little differently.
Original Medicare doesn’t pay for most nursing home care, unless the nursing home is also a skilled nursing facility (SNF), in which case you are entitled to SNF benefits up to 100 days. Most nursing home care helps with activities of daily living, but Original Medicare nursing home coverage is very limited in this aspect.
Medicare Advantage plans (also referred to as Medicare Part C) may offer possible additional routine benefits not included in Original Medicare (Parts A and B). Ask your plan about nursing home coverage before you make any arrangements to enter a nursing home.
Will a Part D Prescription plan help?
In a nursing home setting, your prescriptions will be filled through the facility. Therefore, your Medicare Part D coverage will apply to these expenses. While you’re living in a nursing home or similar facility, you’re free to switch Medicare drug plans. And if you move out of the facility, you can switch plans when you leave. If you’re unable to join a drug plan on your own, your authorized legal representative can do it for you on your behalf.
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Original Medicare and Skilled Nursing Facilities (SNF)
Individuals who require rehabilitation or help with daily needs following a hospital stay may temporarily go to a skilled nursing facility. SNFs are a place for transitional care between the hospital and home. Under most circumstances, and when the stay is needed to meet a medical goal, many SNF services are covered in part or fully by Original Medicare. (Days 1-20 = $0 per benefit period, Days 21-100 = $209.50 coinsurance per day (2025 rate) covered by patient or insurance, Days 101 and beyond = all costs covered by patient or insurance.)
- Semi-private room (a room you share with other patients)
- Meals
- Skilled nursing care
- Physical and occupational therapy
- Speech-language pathology services
- Medical social services
- Medications
- Medical supplies and equipment used in the facility
- Ambulance transportation to the nearest supplier of needed services
- Dietary counseling
How do Original Medicare and Medicaid work together in support of long-term care?
While Original Medicare doesn’t pay for most nursing home care, if the nursing home is also a skilled nursing facility, you are entitled to skilled nursing facility benefits up to 100 days. If you don’t meet Original Medicare’s requirements for a SNF or have reached the limit of coverage, Medicaid may be able to pay for your skilled nursing facility care. In order to be eligible for Medicaid, you must prove that you have income and assets below certain guidelines. The rules on Medicaid differ by state, so it’s vital to contact a Medicaid office in your state to confirm eligibility.
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Original Medicare and Hospice Care
Hospice care involves a variety of care. Original Medicare has assembled a list of services that all hospices are required to provide every hospice patient. Medicare Part A will cover these services when needed during terminal illness and related condition(s) and ordered by your hospice care team:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (such as bandages and catheters)
- Prescription drugs for symptom control or pain relief (you may need to pay a small copayment)
- Hospice aide and homemaker services
- Physical and occupational therapy
- Speech-language pathology services
- Social worker services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care (for pain and symptom management)
- Short-term respite care (may need to pay a small copayment)
- Any other Original Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team
If you require hospice care, Medicare Part A will provide the following:
- 100% of your hospice care costs
- A copayment of up to $5 for prescription drugs needed to provide comfort and control pain related to the terminal illness
- 95% for inpatient respite care. If you receive hospice care at home, respite care gives your daily caregiver a break by arranging for you to receive temporary inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home) on an occasional basis. You can stay in the facility up to five days each time you get respite care.
If you also have a Medicare Supplement Insurance plan:
- Contact the provider of your Medigap policy or reach out to the State Health Insurance Assistance Program (SHIP) for details about your specific plan’s coverage for hospice care.
What’s NOT covered by your Medicare Part A hospice benefits?
While your Original Medicare hospice benefit covers many types of care, it will not cover certain things, such as:
- A treatment or prescription medications intended to cure your terminal illness
- Any care not set up by an approved hospice care team
- Your room and board should you receive hospice care where you live
- Any E.R. care, inpatient care, or ambulance transport not related to your terminal illness or not arranged by your hospice care team
Let SelectQuote Help
We can help you better understand Medicare plan coverage for long-term and hospice care. It’s a free service and there’s no obligation to enroll.
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No obligation to enroll
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