Does the Affordable Care Act cover nursing homes?

Asked by: Myrtice Volkman  |  Last update: September 22, 2025
Score: 4.9/5 (61 votes)

Long-term care: You will need to pay for long-term care if you become disabled or need to move to a nursing home. It's not an essential health benefit under the Affordable Care Act and is not covered by Medicare or most private health plans.

How does the Affordable Care Act relate to nursing homes?

There are several provisions under the ACA that concern nursing homes. For example, the ACA requires the Center for Medicare and Medicaid Services to provide a comprehensive website where consumers may find information regarding local nursing homes, including inspection and complaint reports.

What is not covered under the Affordable Care Act?

What Benefits Does the Affordable Care Act Not Cover? The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.

Which Medicare pays for nursing homes?

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

How do most Americans pay for nursing homes?

The most common payment methods for nursing homes include health care programs like Medicare and Medicaid, as well as private insurance. Eligible veterans and their spouses can also apply for veterans benefits to cover nursing home costs.

Nursing Home Concerns with the Affordable Care Act

38 related questions found

Does social security pay for nursing homes?

Social Security benefits can indeed be used to cover some of the costs associated with nursing home care. These monthly payments, which most seniors receive based on their work history and contributions to the Social Security system, can be directed towards nursing home expenses.

How many days will Medicare pay 100% of the covered costs of care in a skilled nursing care facility?

You pay nothing for covered services the first 20 days that you're in a skilled nursing facility (SNF). You pay a daily coinsurance for days 21-100, and you pay all costs beyond 100 days. Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get current amounts.

What is the biggest drawback of long-term care insurance?

One of the biggest drawbacks of getting long-term care insurance is the risk of losing all the premiums you have paid over the years. If you end up not needing long-term care services, you won't be eligible for coverage. This means the money you've spent for coverage goes down the drain.

What happens after 100 days in a nursing home?

Medicare covers up to 100 days of care in a skilled nursing facility (SNF) each benefit period. If you need more than 100 days of SNF care in a benefit period, you will need to pay out of pocket. If your care is ending because you are running out of days, the facility is not required to provide written notice.

What is the maximum out-of-pocket for the Affordable Care Act?

For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,450 for an individual and $18,900 for a family. For the 2025 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,200 for an individual and $18,400 for a family.

How do I know if I qualify for the Affordable Care Act?

Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.

Does Obamacare cover long-term care?

Many people mistakenly believe their health insurance, whether provided by an employer, bought on an exchange such as Obamacare or Medicare, will pay for long term care. But regular health insurance definitely does not. Medicare sometimes pays for a portion of your long term care but only up to 100 days.

How does the Affordable Care Act affect the elderly?

Seniors Are Guaranteed Free Preventive Services And Annual Check-Ups. Around 61 million people with Medicare have access to free preventive services because of the Affordable Care Act. Additionally, Medicare beneficiaries likely see lower premiums thanks to the cost-saving measures implemented under the ACA.

Is Affordable Care Act based on income?

Under the Affordable Care Act, eligibility for income-based Medicaid and subsidized health insurance through the Marketplaces is calculated using a household's Modified Adjusted Gross Income (MAGI).

How much does it cost to insure a nursing home?

It can vary pretty widely. Yearly premiums can run as low as $1,000 to around $10,000. The insurance company will look at your age, gender, location, marital status, and current health and family health history. You'll also pay more if you choose a longer term or a bigger benefit.

Why would someone be denied long-term care insurance?

When it comes to getting long-term care insurance, your current health matters. In fact, one of the biggest reasons people are denied long-term care insurance is because they have a pre-existing medical condition or disability that makes it more likely they'll require care sooner.

What do you call people who live in nursing homes?

Resident: A person who lives in a residential long-term care setting, such as a nursing home or assisted living community.

What happens to senior citizens when they run out of money?

There is help available for older adults who have run out of money, if you know where to look. The government has many programs that help with needs like healthcare, housing, food, and energy bills. Your local community offers hubs of information like libraries, city hall, and the parks district.

Who most often pays the costs of people living in a nursing home?

The most common source of assistance is Medicaid, which offers several state-based programs to people who are eligible based on income or disability. These programs include home- and community-based services, adult foster care, and Medicaid personal care services. Contact your state Medicaid agency to learn more.

What is the least expensive type of long-term care?

What is the least expensive type of long-term care?
  • Home healthcare: This includes home health aides and any other long-term care support you receive at home.
  • Assisted living communities: This type of long-term care provides housing with round-the-clock staff to help with basic daily living activities.

How much does a nursing home cost with Medicare?

Notably, Medicare only pays for up to 100 days of care in a skilled nursing facility during each benefit period. And, after 20 days, patients are partially responsible for the costs. In 2024, patients without supplemental coverage pay $204 in coinsurance for every covered day between 21 and 100.

What is the 3 midnight rule?

A patient has passed two midnights in Inpatient status and medically no longer requires hospital care. If there are no accepting SNFs (within the confines of a reasonable search) resulting in passage of a third Inpatient midnight in the hospital, the Three Midnight Rule has been fulfilled.

Can a nursing home kick you out if you run out of money?

If you connect with our team of professionals soon enough, they may even be able to help you save some money before it's all gone and still qualify for Medicaid. The unfortunate truth is, nursing homes can discharge residents for lack of payment, but they do have to follow some guidelines while doing it.