Medicare covers a short stay after a qualifying hospital admission, for rehabilitation, not for long-term custodial care. Long stays are paid privately or by Medicaid once assets are spent down.
Medicare Care Compare publishes inspection results, staffing levels and quality measures for every certified home.
Why it matters
The distinction between a Medicare rehabilitation stay and a long-term stay decides who pays, and families are often surprised by it.
Questions people ask
What is a skilled nursing facility?
A skilled nursing facility, commonly called a nursing home, provides round-the-clock nursing care and is federally regulated and rated by Medicare. It serves people who need short-term rehabilitation after a hospital stay as well as people who need long-term care. Medicare Care Compare publishes inspection results, staffing levels and quality measures for every certified facility, so families can compare them.
What is skilled nursing?
Skilled nursing is care that must be given by, or under the supervision of, licensed nurses or therapists, such as intravenous injections, wound care, or physical and occupational therapy. Medicare covers it in a skilled nursing facility when a doctor says you need it daily. It differs from custodial care, which is help with bathing, dressing and eating that does not need a licensed professional.
Is memory care considered skilled nursing?
Not usually. Most memory care is custodial care, meaning supervision and help with daily activities, rather than skilled nursing from licensed nurses. Some nursing homes have memory care units where residents can also receive skilled care when they need it. The difference affects payment: Medicare does not pay for long-term custodial care, while it can cover a short skilled nursing stay.
Is a skilled nursing facility the same as a nursing home?
Mostly, yes. Skilled nursing facility is the Medicare term for a nursing home certified to provide skilled nursing and rehabilitation, and the two names are often used for the same building. The practical difference is the type of stay: a short Medicare covered rehabilitation stay after a hospital admission, or a long-term custodial stay, which is paid privately or by Medicaid.
Does Medicare cover a skilled nursing facility?
Medicare Part A covers a short stay in a skilled nursing facility after a qualifying inpatient hospital stay of at least three days, when you need daily skilled care such as rehabilitation. Coverage is limited to 100 days in each benefit period, and you pay a daily coinsurance from day 21. Medicare does not cover long-term custodial care when that is the only care you need.
Sources
Where to check this, and where to read more. All external and all authoritative.