Does Medicare Pay for Nursing Home for Cancer Patients?

Medicare provides healthcare coverage to millions of Americans, but its coverage for “nursing home” care is often misunderstood. Many assume Medicare covers long-term stays, which is not always true. Medicare’s provisions for care in these settings are specific, focusing on medical necessity rather than prolonged custodial support. This distinction is crucial for beneficiaries to understand their potential financial responsibilities and available benefits.

Understanding Medicare’s Coverage for Nursing Home Care

Medicare generally does not cover long-term custodial care, which involves assistance with daily living activities such as bathing, dressing, and eating. Instead, Medicare Part A, which covers inpatient hospital stays, also extends to care received in a Skilled Nursing Facility (SNF) under specific conditions. An SNF is a facility that provides medically necessary skilled nursing care or therapy services, often on a short-term basis, following a hospital stay. This differs from what many people typically envision as a “nursing home,” which often provides long-term residential care focused on daily activities.

The fundamental difference lies between “skilled care” and “custodial care.” Skilled care involves services that require the skills of qualified technical or professional personnel, such as registered nurses or licensed therapists. Examples include intravenous injections, complex wound care, physical therapy, occupational therapy, or speech-language pathology services. Custodial care, conversely, helps with personal needs and daily living activities that can be provided by non-medical personnel, and Medicare does not cover it. Medicare’s coverage for SNF care is strictly tied to the need for skilled services to treat, manage, or observe a medical condition.

Eligibility Criteria for Skilled Nursing Facility Coverage

For Medicare Part A to cover a stay in a Skilled Nursing Facility, a patient must meet several eligibility requirements. A qualifying hospital stay is a primary condition: the patient must have been admitted to a hospital as an inpatient for at least three consecutive days. This period does not include the day of discharge, and observation stays do not count towards this inpatient requirement. The need for SNF care must also be directly related to the condition for which the patient received hospital inpatient services, or a condition that arose while receiving care in the SNF for the initial condition.

Following the qualifying hospital stay, the patient must be admitted to the SNF within 30 days after leaving the hospital. The care received in the SNF must be medically necessary skilled nursing care or skilled therapy that requires the skills of qualified technical or professional personnel. A doctor must certify the need for these daily skilled services. The care must be something that can only be provided in an SNF and cannot reasonably be provided in another setting, such as at home or on an outpatient basis.

Covered Services and Patient Costs in a Skilled Nursing Facility

When a patient meets the eligibility criteria for an SNF stay, Medicare Part A covers a range of specific services. These include skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services. Medicare also covers other necessary medical services and supplies, such as medications, medical social services, dietary counseling, and the use of durable medical equipment provided by the facility. Room and board are also covered, but only when skilled care is actively being provided to the patient within the facility.

Medicare’s SNF coverage operates within a “benefit period.” This period begins the day a patient is admitted as an inpatient in a hospital or SNF, and ends when they have been out of a hospital or SNF for 60 consecutive days. For each benefit period, Medicare covers up to 100 days of SNF care.

The patient’s cost-sharing varies during this period. Medicare pays 100% of the approved amount for the first 20 days of skilled nursing facility care. For days 21 through 100, the patient is responsible for a daily copayment, which is a set amount that changes annually. In 2025, this daily copayment is $216.50. After day 100 in a benefit period, Medicare does not pay for any skilled nursing facility care, and the patient is responsible for all costs.

Impact of a Cancer Diagnosis on Coverage

A cancer diagnosis itself does not automatically qualify an individual for Medicare Skilled Nursing Facility coverage. Medicare’s determination for SNF coverage remains consistent across all diagnoses, focusing on the type and intensity of care required rather than the specific medical condition. If a cancer patient requires medically necessary skilled nursing care or skilled therapy services following a qualifying hospital stay, then Medicare coverage may apply. For example, a patient recovering from cancer surgery who needs daily wound care or intensive physical therapy would be considered for SNF coverage.

Conversely, if a cancer patient primarily needs assistance with daily living activities, such as help with bathing or eating, without a concurrent need for daily skilled nursing or therapy services, Medicare will not cover the SNF stay. The presence of cancer does not alter the fundamental requirement that the care must be skilled and medically necessary. Therefore, while a cancer diagnosis often necessitates various forms of medical care, eligibility for Medicare SNF benefits hinges solely on meeting the established criteria for skilled care, just as it would for any other patient requiring such services.

Citations

Medicare.gov. “Skilled nursing facility (SNF) care.” Accessed August 25, 2025.