- During a Medicare-covered skilled nursing stay, Part A — not Part D — pays for your medications, for up to 100 days per benefit period.
- Once Part A coverage ends or you move to long-term custodial care, Part D takes over through the facility's long-term care pharmacy.
- While you live in a qualifying facility, you can switch Part D plans once a month, and you get two more months to change plans after discharge.
Moving into a nursing home raises an obvious question: who pays for your prescriptions now? The answer depends on the kind of stay you are in. During a short, Medicare-covered skilled nursing stay, one part of Medicare pays; during a long-term stay, another takes over. Knowing which applies — and when the switch happens — keeps you from surprise bills at the facility pharmacy.
Short-term rehab: Part A pays for your drugs
If you enter a skilled nursing facility for rehabilitation after a qualifying hospital stay of at least three inpatient days, Medicare Part A covers the stay, including medications given as part of your care. You do not bill those drugs through your Part D plan. Part A pays in full for days 1 through 20, and you pay daily coinsurance for days 21 through 100 — $217 per day in 2026. After day 100 of a benefit period, Part A stops paying for the stay entirely.
Your Part D plan is not gone during a skilled stay; it is simply not the payer while Part A is covering the stay. Once the Part A benefit ends — through discharge, loss of skilled-care need, or exhausted days — your Part D plan resumes covering your prescriptions.
Long-term care: Part D takes over
Medicare does not pay for long-term custodial care — the room, board, and personal care of living in a nursing home indefinitely. But drug coverage continues: once you are in long-term care, your Part D plan covers your medications with the same deductible, copays, and out-of-pocket rules as at home. In 2026, the standard deductible is capped at $615, and once out-of-pocket spending on covered drugs reaches $2,100, you pay $0 for covered drugs for the rest of the year.
One practical change: prescriptions will usually be filled by a long-term care pharmacy serving the facility, rather than your old neighborhood pharmacy. Part D plans must maintain a network of long-term care pharmacies, so check that your plan works with your facility's pharmacy. If it does not, that is a good reason to switch plans — and living in a facility gives you the freedom to do so at any time.
Stronger protections inside a facility
Long-term care residents get extra safeguards:
- Transition fills. If your new plan does not cover a drug you were already taking, or restricts it with prior authorization or step therapy, the plan must provide a temporary supply — up to 31 days through a long-term care pharmacy — while you and your doctor sort out an exception or alternative.
- Emergency supplies. If an exception request is still pending, the plan must provide an emergency supply so your treatment is not interrupted.
- No coverage-gap surprises. The old "donut hole" was eliminated in 2025, so you move straight from initial coverage to the $2,100 out-of-pocket cap, just as at home.
- Vaccines at $0. CDC-recommended adult vaccines, including flu, COVID, RSV, and shingles shots, are covered at $0 under Part D.
If you also qualify for Medicaid — common for long-term residents — you generally receive Extra Help automatically, which sharply lowers or eliminates your Part D premium, deductible, and copays. Without Medicaid, your Part D premium is still due while you live in the facility, so keep the plan paid up unless you switch.
You can switch plans once a month
Moving into a qualifying institution gives you a special enrollment period that lasts as long as you live there. While you reside in the facility, you may join, drop, or switch Part D plans once per month — you do not have to wait for the Annual Enrollment Period (October 15 to December 7). After you leave, you get two full months to make one final plan change.
One option worth knowing about is an Institutional Special Needs Plan (I-SNP), a Medicare Advantage plan designed specifically for people living in long-term care facilities, though availability depends on your area and facility.
What to do when a move is planned
Work through this short checklist before or soon after the move:
- Tell the facility which Part D plan you have, and confirm the facility's long-term care pharmacy is in your plan's network.
- Ask the facility's billing staff exactly when Part A coverage for the stay ends, so you know when Part D billing resumes.
- Review the plan's formulary against your medication list, and start exception requests early for any drug that is not covered.
- If you qualify for Medicaid or Extra Help, make sure the plan and the facility both have that on file.
- If the plan is a poor fit — wrong pharmacy network, key drug not covered — use the monthly special enrollment period to switch rather than waiting for open enrollment.
A move into a nursing home is stressful enough without drug-coverage surprises. The rules are designed to protect you: Part A handles medications during a covered skilled stay, Part D takes over for the long term, and you are never locked into a plan that does not work where you live.
Bottom line: Your Part D plan does not disappear when you enter a nursing home — Part A covers drugs during a skilled stay, Part D takes over for long-term care, and you can switch plans once a month while you live there.