Medicare vs. Medicaid: Which One Pays for Nursing Homes?

This is the most common misconception I hear: "Medicare will pay for my nursing home."

No. It won't. At least not for long-term care.

Let's clear this up once and for all.

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Medicare: Short-Term Rehab Only

What Medicare covers:

Medicare Part A covers nursing home care ONLY if you're recovering from a qualifying hospital stay.

The rules:

You must be in the hospital for at least 3 days

You enter the nursing home within 30 days of hospital discharge

You need skilled nursing care or rehab therapy

You're making progress (getting better)

What Medicare pays:

Days 1-20: 100% covered

Days 21-100: You pay ~$200/day copay

After day 100: Medicare stops. You're on your own.

What Medicare does NOT cover:

Long-term care (if you're living there permanently)

Custodial care (just help with daily activities)

Care if you're not improving

Bottom line: Medicare is for short-term recovery, not permanent residence.

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Medicaid: The Real Long-Term Care Solution

What Medicaid covers:

Medicaid covers long-term nursing home care for people who meet income and asset requirements.

Who qualifies:

Income below ~$2,800/month (varies by state)

Assets under ~$2,000 (home and car usually don't count)

Medically need nursing home care

What Medicaid pays:

Room and board

All nursing care

Medications

Therapy

Medical supplies

The catch:

You have to "spend down" your savings first. You can't be wealthy and get Medicaid.

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The Typical Path

Here's how it usually goes:

1. Hospital stay → Medicare covers

2. Short-term rehab in nursing home → Medicare covers (up to 100 days)

3. Can't go home, need long-term care → Medicare stops

4. Pay privately for months or years until money runs out

5. Apply for Medicaid once assets are spent down

6. Medicaid takes over for the rest of their life

Most people don't plan for step 4. That's the expensive part.

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Can You Have Both?

Yes! Some people are "dual eligible"—they have both Medicare and Medicaid.

Medicare covers medical costs (doctor visits, hospital stays).

Medicaid covers long-term care costs (nursing home).

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What About Medicare Advantage?

Medicare Advantage plans (Part C) have the same rules as Original Medicare.

They cover short-term rehab, but NOT long-term care.

Some plans offer extra benefits, but don't count on them for nursing home coverage.

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The Bottom Line

Medicare = short-term rehab

Medicaid = long-term care

If your loved one needs to live in a nursing home permanently, Medicaid is what will pay—once their money runs out.

Plan accordingly.