Table of ContentsView AllTable of ContentsWhat Is a Nursing Home?Increasing Needs for CareCost of Nursing Home CareMedicare and Nursing HomesWhen Medicare Stops Paying
Table of ContentsView All
View All
Table of Contents
What Is a Nursing Home?
Increasing Needs for Care
Cost of Nursing Home Care
Medicare and Nursing Homes
When Medicare Stops Paying
Eva-Katalin / E+ / Getty Images
For example, nursing homes often provide assistance with bathing, cleaning, cooking, dressing, hygiene, and even walking or mobilizing.Nursing home employees who provide this type of assistance do not have to have medical training.
Unfortunately, many seniors in nursing homes are there for reasons of safety. They are unable to live independently due todementiaor other medical conditions, and they may not have family or loved ones who can support them.
An Increasing Need for Nursing Home Care
According to the same HHS report, there were 1.7 million licensed nursing home beds available in 2016 and 1.4 million long-term residents in those beds. Around 16.1% of those residents were between 65 and 74 years old. Around 25.5% were between 75 and 84 years old, and 43.5% were 85 years and older.
The Real Cost of Nursing Home Care
According to the Genworth Cost of Care Survey, the average monthly cost in the United States for a shared room in 2021 is $7,908 per month. For a private room, it is $9,034 per month. This means the average nursing home costs a resident $94,900 per year for a shared room and $108,405 for a private room.
Nursing home costs vary based on where you live. The five most expensive states are Alaska, Connecticut, Massachusetts, New York, and Hawaii, in that order, with some nursing homes in Alaska costing as much as $24,000 per month.The least expensive states for nursing home care are Oklahoma, Missouri, Louisiana, Kansas, and Arkansas, with average monthly rates in the $5,000s.
Nursing home costs vary based on where you live. The five most expensive states are Alaska, Connecticut, Massachusetts, New York, and Hawaii, in that order, with some nursing homes in Alaska costing as much as $24,000 per month.
The least expensive states for nursing home care are Oklahoma, Missouri, Louisiana, Kansas, and Arkansas, with average monthly rates in the $5,000s.
The average payout for Social Security retirement benefits in January 2022 was $1,660.90 per month for a total of $19,930.80 per year.This makes nursing homes too expensive for the average Social Security recipient. There are alternatives for people who need nursing home care, however, these are only available under specific circumstances.
Does Medicare Pay for Nursing Home Care?
Medicare pays for nursing home care if you were recently admitted to the hospital and you require skilled care at least five days per week. To qualify for this Medicare Part A coverage, you need to have been admitted to the hospital as an inpatient for at least three days. The day you are transferred to the skilled nursing facility does not count as one of the three days.
If you do get approval for skilled nursing care, Medicare Part A covers the first 20 days for you. For days 21 to 100, you will pay $194.50 per day (as of 2022). After 100 days, you are required to pay for your own care.
What Services Does Medicare Pay For?
Some of the services Medicare will cover during your stay in a skilled nursing facility include:
How Medicaid Asset Protection Trusts Work
What to Do When Medicare Stops Paying for Nursing Home Care
You may have other options once Medicare stops paying for nursing home care. These options will vary depending on your circumstances.
Medicaid Coverage for Nursing Home Care
Because Medicare only offers short-term nursing home care, many people turn toMedicaid. According to the 2019 Vital Health Statistics report, 61.2% of residents in nursing homes used Medicaid as their payment source.
Not everyone qualifies for Medicaid. Eligibility differs for children, pregnant women, and other adults. States that expanded Medicaid underthe Affordable Care Actopened eligibility to single individuals without children, but other states may exclude those individuals from coverage.
Medicaid is intended for people with low incomes. Eligibility is based on your monthly income and your assets. These assets include:
Each state ultimately sets its own financial threshold for eligibility, but the federal government sets a minimum requirement for each state. You will need tolook up requirements for your stateto see if you qualify.
If you choose the latter, make sure to consult an elder law attorney to discuss your options, since the transfer must not have occurred within 60 months of your Medicaid application. Transfers that occur during this look-back period could result in penalties from Medicaid, potentially delaying your care coverage for months to years. This will depend on how much money you transfer and in what state you live.
Private Coverage for Nursing Home Care
It is possible to purchase long-term care (LTC) insurance to help pay for nursing home care. These insurance plans are used to pay for around 10% of nursing home expenses in the United States.
LTC insurance can be helpful if you need care, but premiums tend to be expensive and out of range for many people. These premiums tend to get higher the older you get, especially if your health is on the decline. Individuals over 65 years old and who have chronic medical problems could see monthly premiums in the thousands of dollars. Insurance companies can also deny coverage based onpre-existing conditions.
Long-term care insurance pays out when you have a triggering event that requires nursing home or long-term home health care. Those payouts can be put towards care-specific services, but the amount will be based on your specific LTC insurance plan. They may or may not cover the full cost of care, and the payouts may only last a certain length of time.
Other Options to Pay for Care
If you can’t afford to pay out of pocket, there may be other options for obtaining care after Medicare stops paying. These options will depend on how much support you have from family and what alternatives are available in your state or local area. For example:
Summary
The cost of nursing home care far exceeds the average Social Security retirement benefit, leaving the cost out of reach for many people.
Unfortunately, Medicare only covers nursing home care for a short period and only after an inpatient hospital stay. The majority of people turn to Medicaid for coverage but this could require you to spend down your assets to become eligible. Some people may turn to long-term care insurance instead.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Centers for Medicare & Medicaid Services.Custodial Care vs. Skilled Care.U.S. Department of Health and Human Services Vital Health Statistics.Long-term Care Providers and Services Users in the United States.U.S. Census Bureau.2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers.Centers for Disease Control & Prevention.FastStats - Life Expectancy.Medina L, Sabo S, Vespa J.Population Estimates and Projections Current Population Reports.; 2020.Alzheimer’s Association.Alzheimer’s Disease Facts and Figures.Genworth.Cost of Care Survey.Genworth.Cost of Care Survey.U.S. Social Security Administration.Monthly Statistical Snapshot, January 2022.U.S. Centers for Medicare & Medicaid Services.Skilled nursing facility (SNF) care.Medicare.gov.Skilled nursing facility (SNF) care.Gruber J, McGarry KM.Long-term care in the United States. National Bureau of Economic Research.
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Centers for Medicare & Medicaid Services.Custodial Care vs. Skilled Care.U.S. Department of Health and Human Services Vital Health Statistics.Long-term Care Providers and Services Users in the United States.U.S. Census Bureau.2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers.Centers for Disease Control & Prevention.FastStats - Life Expectancy.Medina L, Sabo S, Vespa J.Population Estimates and Projections Current Population Reports.; 2020.Alzheimer’s Association.Alzheimer’s Disease Facts and Figures.Genworth.Cost of Care Survey.Genworth.Cost of Care Survey.U.S. Social Security Administration.Monthly Statistical Snapshot, January 2022.U.S. Centers for Medicare & Medicaid Services.Skilled nursing facility (SNF) care.Medicare.gov.Skilled nursing facility (SNF) care.Gruber J, McGarry KM.Long-term care in the United States. National Bureau of Economic Research.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. Centers for Medicare & Medicaid Services.Custodial Care vs. Skilled Care.U.S. Department of Health and Human Services Vital Health Statistics.Long-term Care Providers and Services Users in the United States.U.S. Census Bureau.2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers.Centers for Disease Control & Prevention.FastStats - Life Expectancy.Medina L, Sabo S, Vespa J.Population Estimates and Projections Current Population Reports.; 2020.Alzheimer’s Association.Alzheimer’s Disease Facts and Figures.Genworth.Cost of Care Survey.Genworth.Cost of Care Survey.U.S. Social Security Administration.Monthly Statistical Snapshot, January 2022.U.S. Centers for Medicare & Medicaid Services.Skilled nursing facility (SNF) care.Medicare.gov.Skilled nursing facility (SNF) care.Gruber J, McGarry KM.Long-term care in the United States. National Bureau of Economic Research.
U.S. Centers for Medicare & Medicaid Services.Custodial Care vs. Skilled Care.
U.S. Department of Health and Human Services Vital Health Statistics.Long-term Care Providers and Services Users in the United States.
U.S. Census Bureau.2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers.
Centers for Disease Control & Prevention.FastStats - Life Expectancy.
Medina L, Sabo S, Vespa J.Population Estimates and Projections Current Population Reports.; 2020.
Alzheimer’s Association.Alzheimer’s Disease Facts and Figures.
Genworth.Cost of Care Survey.
U.S. Social Security Administration.Monthly Statistical Snapshot, January 2022.
U.S. Centers for Medicare & Medicaid Services.Skilled nursing facility (SNF) care.
Medicare.gov.Skilled nursing facility (SNF) care.
Gruber J, McGarry KM.Long-term care in the United States. National Bureau of Economic Research.
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