Quick Answer: Medicare covers short-term skilled nursing and rehabilitation care at a CCRC when the facility is Medicare-certified but does not cover long-term care. Medicaid may help cover long-term nursing home costs for residents who meet income and asset requirements, though eligibility rules vary. At Havenwood Heritage Heights, our team helps residents and families understand how both programs can work together to support their care.

If you're exploring a continuing care retirement community in Concord, questions about paying for care are likely near the top of your list. Medicare and Medicaid are two of the most frequently misunderstood programs in senior living, and the confusion is understandable: their names sound similar and their roles are entirely different.

This article breaks down what each program covers at a CCRC, what they don't cover, and how both programs can factor into your long-term financial plan.

Contents

Medicare and CCRCs: What's Covered?

Medicare Part A covers medically necessary skilled nursing care on a short-term basis, but only when specific requirements are met. To qualify, a resident must have had a hospital inpatient stay of at least three consecutive days before admission to the skilled nursing facility (SNF). The care must begin within 30 days of that hospital discharge, a physician must determine that daily skilled nursing or rehabilitation is necessary, and the facility must be Medicare-certified.

When those conditions are met, Medicare covers the full cost of skilled nursing care for the first 20 days of a benefit period. From days 21 through 100, Medicare covers most of the cost, but residents are responsible for a daily coinsurance amount, which is $217.00 per day in 2026. After day 100, Medicare coverage ends entirely for that benefit period. It is also important to understand that the length of coverage throughout this period depends on the resident continuing to meet skilled nursing level of care criteria. If a resident no longer requires skilled nursing or rehabilitation services, Medicare coverage may end before the 100-day maximum is reached.

Medicare Part B covers physician visits, outpatient care, and certain therapies regardless of where a resident lives, including at a CCRC. This means doctor appointments, lab work, and services like physical or occupational therapy ordered by a physician can be covered through Part B even when a resident is in independent living.

An important point: not all CCRC skilled nursing facilities are Medicare-certified. If a community's healthcare center does not hold Medicare certification, residents pay the full cost of skilled nursing from day one. When evaluating a CCRC, ask directly whether their on-site health center is Medicare-certified.

What Medicare Does Not Cover

This is where many families are surprised. Medicare does not cover assisted living, memory care, or long-term custodial care, regardless of where that care is provided. Custodial care refers to help with activities of daily living such as bathing, dressing, eating, and toileting. Because these services are considered non-medical, they fall entirely outside Medicare's scope.

In practical terms, this means that a resident who moves from independent living into a CCRC's assisted living or memory care neighborhood will not receive Medicare reimbursement for those services. The same is true for long-term skilled nursing stays once the 100-day benefit period is exhausted.

Medicare Advantage and Medigap

Many residents carry supplemental coverage that works alongside original Medicare. A Medicare Supplement (Medigap) plan may cover some or all of the daily coinsurance for days 21 through 100 in a skilled nursing facility, reducing out-of-pocket exposure during a qualifying stay.

Medicare Advantage (Part C) plans replace original Medicare and may offer different coverage rules for skilled nursing stays. Some plans offer extended SNF benefits or reduced cost-sharing. If you or a family member is enrolled in a Medicare Advantage plan, verify that the CCRC's skilled nursing facility is in-network before making a move.

Medicaid and CCRCs

While Medicare is designed for short-term, medically necessary care, Medicaid is a joint federal and state program that helps cover the costs of long-term care for people who meet income and asset eligibility requirements. For seniors in a CCRC, Medicaid most often becomes relevant when a resident has spent down personal assets and can no longer afford the full cost of skilled nursing care.

It is important to understand that Medicaid pays less than the full market rate for skilled nursing care. The difference between what Medicaid reimburses and the actual cost of care must be absorbed by the facility. This is one reason why not all nursing homes accept Medicaid, and why a community's financial strength matters when evaluating a CCRC.

If a CCRC's health center is Medicaid-certified, residents who qualify may be able to transition to Medicaid coverage for ongoing skilled nursing costs without having to move to a different facility. This continuity of care is one of the most meaningful benefits of choosing a well-established CCRC.

Medicaid Eligibility in New Hampshire

In New Hampshire, Medicaid for long-term care is available to seniors who meet medical necessity criteria and fall within income and asset limits. To qualify for Nursing Home Medicaid, an applicant must generally have limited countable assets. New Hampshire also offers a spend-down pathway for residents whose income exceeds the eligibility limit: by applying excess income toward qualifying medical expenses, a senior can reduce their counted income to meet the program threshold.

New Hampshire has a 60-month (five-year) look-back period for nursing home Medicaid. This means the state reviews asset transfers made in the five years before the application to ensure assets were not gifted away to qualify for benefits. Residents who transferred assets during this window may face a penalty period during which Medicaid will not cover their care.

Because Medicaid planning is complex and highly individualized, families are encouraged to consult with a certified Medicaid planner or elder law attorney well before care is needed. The application process in New Hampshire can take up to 90 days, and planning allows for more options.

How CCRC Contracts Affect Medicare and Medicaid

The type of contract you sign when entering a CCRC has a significant effect on how Medicare and Medicaid interact with your care costs.

Under a Type A (Life Care) contract, residents pay a higher entrance fee and monthly fee in exchange for access to all levels of care at little or no additional monthly cost. When a resident in a Life Care community requires skilled nursing care, Medicare pays its applicable reimbursement to the CCRC even though the resident continues paying the same monthly rate. Once Medicare coverage ends, the CCRC remains responsible for absorbing the difference between the cost of care and the resident's monthly fee.

Under Type B (Modified) and Type C (Fee-for-Service) contracts, residents pay closer to market rate for skilled nursing care. In these arrangements, Medicare reimbursement during a qualifying stay directly offsets what the resident owes, but once benefits are exhausted, care costs increase significantly. For residents who transition to Medicaid, the CCRC's acceptance of Medicaid and its certification status become especially important.

As one of just three CARF-accredited CCRCs in New Hampshire, Havenwood Heritage Heights provides a full continuum of care on our campuses, including independent living, assisted living, memory care, skilled nursing, and rehabilitation.

We understand that Medicare and Medicaid questions are deeply tied to the larger question of whether a CCRC is the right financial decision. Our admissions team works closely with prospective residents and their families to help them understand how insurance coverage, government programs, and personal financial resources can work together to support a long and secure retirement.

If you are ready to learn more about our community and what to expect financially, we welcome you to contact us to schedule a personalized tour and conversation with our admissions team.

Trying to figure out when it makes sense to make the move? Read our guide on how to evaluate CCRCs in New Hampshire for a step-by-step look at the decision.