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Dear Connie,
My mother’s health is deteriorating, and I’m looking into long-term care options. I’m confused. What is the difference between assisted living and nursing homes?
My mother has a Medicare Advantage plan, and I’m wondering, does Medicare cover nursing homes?
Confused by Medicare coverage,
Jennifer from Evanston, Illinois
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Local, licensed insurance agents with 25+ years of experienceDear Jennifer,
Researching the proper care for a family member can be difficult, and we know that Medicare can be confusing. We’re here to support you throughout your journey.
You have great questions. And there needs to be more clarity about the difference between assisted living and nursing homes. I’ll do my best to review the differences and answer your question about whether Medicare covers nursing home care.
Both assisted living and nursing homes work to keep a loved one safe, healthy, happy, and supported in their Activities of Daily Living (ADLs). These include help bathing, dressing, and with personal care.
The primary difference between assisted living and nursing homes is the amount and type of care provided. Assisted living environments feel more home-like, and rooms usually have a bathroom and kitchenette. Residents in assisted living keep much of their independence and participate in activities.
Agent tip:
“If finances are limited, you can apply for Medicaid in your state. Between long-term care insurance, personal funds, and Medicaid, we can help you discover long-term care options.“
Nursing home residents typically need 24-hour, around-the-clock care and monitoring. The medical care at nursing homes is usually more complex and custodial, requiring skilled nursing or specialists in speech pathology, physical therapy, occupational therapy, and more.
Between these two options, you may see that one is better for your mother than another. If she does not need a nursing home now, and assisted living is a better option, then you may want to plan for that – with the eventuality of nursing home care.
To learn more about assisted living care, read “Does Medicare cover assisted living?”
Original Medicare and Medicare Advantage plans do not pay for nursing homes or assisted living care. And the cost is significantly different between assisted living and nursing homes. The average assisted living facility could cost $4,995 per month, while a nursing home averages between $8,669 per month for a shared room and $9,733 per month for a private room. That’s $59,940 per year for assisted living and between $104,028 and $117,276 per year for a nursing home.
Free, unbiased serviceCompare all major plans and carriers Local, licensed insurance agents with 25+ years of experienceMany people enroll in long-term care insurance plans for long-term nursing home care. This insurance can help pay for skilled and non-skilled care in various facilities. So, depending on your mother’s needs, a long-term insurance plan could help with nursing home care, adult day care, assisted living, medical equipment, and informal home care.
Alternatively, nursing home care can be paid for with personal funds. If funds are limited, your mother could qualify for Medicaid in your state. Qualifications vary from state to state, and you should check Medicaid eligibility in your state.
I hope this information was helpful. Funding care can be challenging, but it’s possible with long-term care insurance, personal funding, or Medicaid. And Connie Health is here to help you determine which option works best.
If you’d like to discuss the options, please call a licensed agent in your community. Connie Health agents are here to support you and your mother throughout the Medicare journey—call (623) 223-8884 to speak with an agent.
No, Original Medicare does not cover nursing home costs. These costs are typically covered through long-term care insurance, personal funds, or Medicaid. You may want to contact your state’s Medicaid office for eligibility requirements if finances are limited.
However, Medicare Part A will cover Skilled Nursing Facility Care for up to 100 days in a benefit period and limited home health care.
Do you have questions about your situation? Connie Health agents are here to support you throughout the Medicare journey. Call (623) 223-8884 to speak with a local licensed Connie Health agent.
No, Original Medicare does not cover nursing home care for dementia.
Original Medicare does not cover 24-hour care. However, part-time at-home care is provided. Nursing home care for dementia is usually funded through long-term care insurance, personal funds, or Medicaid. Your state’s Medicaid office can help you determine Medicaid eligibility.
Have nursing home questions? Call (623) 223-8884 to speak with a local licensed Connie Health agent.
Original Medicare does not pay for full-time, long-term nursing home care. Nursing home care is usually funded through long-term care insurance, personal funds, or Medicaid. Your state’s Medicaid office can help you determine Medicaid eligibility.
Medicare Part A will cover care in a Skilled Nursing Facility for up to 100 days in a benefit period and limited home health care. Deductibles and coinsurance may apply.
Have questions about coverage? Call (623) 223-8884 to speak with a local licensed Connie Health agent.
Read more by Renee van Staveren
Since 2009, I've been writing about complicated, technical issues, with the goal of making topics like Medicare and healthcare easier to understand. I've been writing about Medicare since 2021 and healthcare since 2019. I am an AmeriCorps alumni. I enjoy gardening, reading, and DIYing.
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