What Happens When Medicare Stops Paying for Nursing Home Care? (Updated October 2025)

When Medicare stops covering nursing home or skilled nursing facility (SNF) care, many patients and families wonder what options are available.

This can be a stressful transition, but understanding Medicare’s coverage limitations and exploring alternative funding sources can help ensure continued care for yourself or a loved one.

What Does Medicare Cover for Nursing Home Care?

Medicare covers short-term stays in a skilled nursing facility (SNF) under specific conditions. Here’s a summary of what’s covered:

• Up to 100 Days of Skilled Nursing Care: Medicare Part A covers a limited stay in an SNF after a qualifying hospital stay of at least three days. This includes skilled nursing care, physical therapy, occupational therapy, medications, and other necessary treatments.
• Cost Structure:
  • Days 1-20: Medicare covers the full cost.
  • Days 21-100: Medicare requires a daily copayment of $209.50 in 2025 (up from $204 in 2024).
  • After 100 Days: Medicare stops covering SNF care entirely.

Important: Medicare only covers SNF care for patients who need skilled medical services on a daily basis. Once a patient no longer needs daily skilled care or reaches the 100-day limit, Medicare coverage ends.

Note for Medicare Advantage Plans: Some Medicare Advantage plans may waive the 3-day hospital stay requirement and could charge copayments during the first 20 days. Contact your plan for specific details about your coverage.

What Are the Options When Medicare Stops Paying for Nursing Home Care?

When Medicare coverage ends, there are several options for funding ongoing care. Here's a breakdown of common options to consider:

1. Medicaid

Medicaid is a federal and state program that helps cover healthcare costs for individuals with limited income and assets. Unlike Medicare, Medicaid can cover long-term nursing home care if you meet eligibility requirements.

• Financial Eligibility for 2025:
  • Income limit: $2,901/month for a single applicant in most states
  • Asset limit: $2,000 for a single applicant in most states
  • For married couples with only one spouse needing care, the Community Spouse Resource Allowance protects up to $157,920 in assets for the non-applicant spouse
• Look-Back Period: Most states have a 60-month look-back period during which Medicaid reviews all asset transfers to ensure nothing was given away to qualify for benefits.
• Coverage: Medicaid covers long-term care in a nursing home for eligible individuals, with no time limit. However, beneficiaries must contribute most of their income toward their care costs, keeping only a small personal needs allowance (typically $30-$160/month depending on the state).

Tip: If you're over the income limit, ask about Qualified Income Trusts (Miller Trusts) which can help you qualify. Consider talking to a Medicaid planner or elder law attorney for guidance on eligibility and asset protection strategies.

2. Private Pay (Out-of-Pocket)

If Medicaid is not an option, you may need to pay out-of-pocket for nursing home care.

• Costs: Nursing home costs vary by location but average over $100,000 per year nationally. Private rooms average around $10,965 per month in 2025, though costs can be substantially higher in certain regions.
• Using Personal Assets: Families may need to use personal savings, retirement funds, sell property, or consider reverse mortgages to cover costs.

Pro Tip: Some facilities may offer payment plans or sliding scale fees for patients paying privately. Get a Solace advocate to help negotiate rates and explore all payment options. Our advocates are covered by Medicare.

3. Long-Term Care Insurance

If you have long-term care insurance, it may cover nursing home care once Medicare stops paying.

• Coverage: Long-term care policies typically cover various levels of care, including skilled nursing, assisted living, and home health services. Benefits and coverage periods vary widely by policy.
• Limitations: Policies have specific terms regarding when benefits begin, how much they pay daily, and for how long. Many policies also include inflation protection to help benefits keep pace with rising costs.
• Cost Considerations: For those considering purchasing coverage, annual premiums for a $165,000 benefit policy average $950 for single males and $1,500 for single females at age 55.

Important: Long-term care insurance must be purchased before you need it, as it's difficult to qualify with pre-existing health conditions. Get a Solace advocate insurance expert to help review your policy and maximize your benefits.

4. Veterans Benefits

If you or your loved one is a U.S. veteran, you may qualify for additional support through Veterans Affairs (VA) benefits.

• VA Nursing Homes: The VA operates its own nursing home facilities, which provide long-term care for eligible veterans.
• Aid and Attendance Benefit: This benefit offers monthly financial support for qualifying veterans and surviving spouses who need help with daily living activities. 2025 benefit rates:
  • Single veteran: $2,358/month
  • Married veteran: $2,795/month
  • Surviving spouse: $1,515/month
• Eligibility Requirements: Veterans must meet service requirements and have a net worth under $155,356 in 2025. There's a 36-month look-back period for asset transfers.

Note: VA benefits alone rarely cover the full cost of nursing home care but can significantly reduce out-of-pocket expenses when combined with other resources.

How to Plan for Nursing Home Costs After Medicare Ends

It's wise to explore all available options and plan for nursing home care costs, especially if long-term care is anticipated.

• Assess Eligibility for Medicaid: If nursing home care is a long-term need, Medicaid may be the most affordable option. Start the application process early, as approval can take several months. Consider "spending down" assets appropriately to qualify.
• Review Veterans Benefits: Veterans and their spouses should explore all VA benefits, including Aid and Attendance, which can provide crucial monthly income to help with care costs.
• Consider Long-Term Care Insurance: For those who haven't yet needed nursing home care, long-term care insurance can offer essential protection. Explore policy options while you're still healthy enough to qualify.
• Protect Your Assets: Work with an elder law attorney to understand legal ways to protect assets while qualifying for benefits, including trusts, spousal protections, and proper spend-down strategies.

Tip: Even if Medicare coverage ends, proactive planning can prevent financial strain and keep quality care accessible.

How a Solace Advocate Can Help Navigate This Transition

When Medicare stops paying for nursing home care, the path forward can feel overwhelming. This is where a Solace advocate becomes invaluable. Our advocates are healthcare professionals who know the system inside out and can guide you through every option.

Here's how a Solace advocate helps when Medicare coverage ends:

Immediate Assessment and Planning

• Review your current Medicare coverage and identify exactly when benefits will end
• Evaluate your medical needs to determine if you still qualify for skilled care coverage
• Help appeal Medicare coverage denials if skilled care is still medically necessary
• Create a comprehensive plan for transitioning to alternative funding sources

‍Financial Resources and Programs

• Research state and local programs that might provide financial assistance
• Identify nonprofit organizations and charities that help with nursing home costs
• Negotiate with facilities for better rates or payment plans
• Help find facilities that match your budget and care needs
• Connect you with financial counselors specializing in elder care

Family Communication and Coordination

• Keep family members informed about coverage changes and options
• Facilitate family meetings to discuss care decisions and financial planning
• Provide clear explanations of complex Medicare, Medicaid, and insurance rules
• Help families understand what to expect during the transition

Ongoing Support

• Monitor changes in your eligibility status for various programs
• Stay updated on policy changes that might affect your benefits
• Provide emotional support during this stressful transition
• Ensure continuity of care as funding sources change
• Review and adjust your care plan as needs evolve

With a Solace advocate, you don't have to figure this out alone. We've helped countless families navigate the transition when Medicare coverage ends, finding solutions they didn't know existed and securing funding they thought was out of reach. Find a Solace advocate today and get expert guidance through this challenging time.

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FAQ: Questions on Nursing Home Care

How long does Medicare cover nursing home care?

Medicare covers up to 100 days in a skilled nursing facility after a qualifying hospital stay, with full coverage for the first 20 days and a daily copayment required for days 21-100.

Does Medicaid cover long-term nursing home care?

Yes, Medicaid can cover long-term care in a nursing home for eligible individuals, without a time limit, as long as they meet income and asset requirements.

What happens if a patient’s health improves?

If the patient no longer needs daily skilled care, Medicare coverage ends. In this case, they may still qualify for custodial care, which is not covered by Medicare, or explore Medicaid if eligible.

Can Medicare patients return to the SNF if they need skilled care again?

Yes, if the patient has a new qualifying hospital stay of at least three days, they may qualify for a new benefit period of up to 100 days of SNF coverage.

What are other payment options after Medicare stops covering nursing home care?

Options include Medicaid, private pay, long-term care insurance, and veterans benefits, depending on eligibility and available resources.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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