Medicare covers some nursing home care, but only under specific conditions
Medicare pays for skilled nursing facility care — not custodial care in a nursing home. The difference matters: skilled care means medical treatment or rehabilitation that requires a nurse or therapist. Custodial care means help with daily living — bathing, dressing, meals — which Medicare does not cover. If you need only custodial care, Medicare will not pay, and you will need to cover costs yourself or turn to Medicaid.
To get Medicare coverage in a nursing home, you must first spend at least three consecutive days in a hospital (not counting the discharge day). Then you must move to a Medicare-certified skilled nursing facility within 30 days. The facility must be treating a condition related to the hospital stay. Medicare will then cover up to 100 days per benefit period, though you pay a daily copay after day 20.
Many people assume "nursing home" automatically means Medicare will pay. It does not. The type of care you receive and the reason you are there determine whether Medicare covers it. Understanding this distinction before you enter a facility can prevent a surprise bill.
Key Takeaways
- Medicare covers skilled nursing care — medical treatment or rehabilitation — but not custodial care like bathing or dressing.
- You must spend at least three consecutive days in a hospital before Medicare will cover nursing home care.
- Medicare covers up to 100 days per benefit period in a Medicare-certified skilled nursing facility, with copays starting on day 21.
- If you need only custodial care, Medicare does not pay; Medicaid or private payment becomes your option.
- The nursing home must be certified by Medicare and the care must relate to your hospital stay for coverage to begin.
The three-day hospital stay requirement
Medicare will not cover nursing home care unless you have been an inpatient in a hospital for at least three consecutive days first. The discharge day does not count — so if you are admitted on Monday and discharged on Thursday, that counts as three days. Observation status does not count; you must be admitted as an inpatient.
This requirement trips up many people. You cannot go directly from your home to a nursing home and have Medicare pay. You must go through the hospital first. If your doctor recommends a nursing home but you have not been hospitalized, Medicare will not cover it, even if you are very ill or recovering from surgery done in an outpatient setting.
The hospital stay must also be for a condition related to why you need the nursing home. If you are hospitalized for pneumonia and then move to a nursing home for pneumonia recovery, that qualifies. If you are hospitalized for pneumonia but then move to a nursing home for arthritis treatment, Medicare will not cover the nursing home stay.
What counts as skilled nursing care versus custodial care
Skilled care requires the ongoing involvement of a nurse, therapist, or other medical professional. Examples include wound care after surgery, physical therapy after a stroke, intravenous medication, catheter management, or monitoring of a new medication. Skilled care is time-limited — it is meant to help you recover or stabilize, not to be permanent.
Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, moving around. Many nursing homes provide custodial care. Medicare does not cover it. If you need a nursing home only because you cannot bathe or dress yourself, Medicare will not pay, even if nurses work at the facility.
A single nursing home stay can include both. For example, you might receive skilled physical therapy for three weeks after a hip fracture, then need custodial care for another month. Medicare covers the three weeks of therapy. For the month of custodial care, you pay out of pocket or Medicaid covers it (if you may have access to).
The nursing home's care plan will specify what type of care you are receiving. Ask to see it. If it lists only custodial care, Medicare will not cover any of it, regardless of how many days you stay.
Medicare coverage limits and your out-of-pocket costs
Medicare covers up to 100 days in a skilled nursing facility per benefit period. A benefit period starts the day you are admitted to the hospital and ends 60 days after you leave the nursing home (or hospital, if you do not go to a nursing home). If you return to the hospital and then to a nursing home again, a new benefit period begins.
You pay nothing for days one through 20. Starting on day 21, you pay a daily copay. The copay amount changes each year; in 2024 it is $200 per day, but confirm the current amount with your nursing home or Medicare. After day 100, Medicare pays nothing, and you are responsible for all costs.
If you need more than 100 days of skilled care in one benefit period, you must pay out of pocket or use another source of coverage. Some people have supplemental insurance (Medigap) that covers some of these costs. Medicaid covers skilled nursing care for those who may have access to, with no day limit.
How to confirm a nursing home is Medicare-certified
Not all nursing homes accept Medicare. Before you move to one, confirm it is Medicare-certified. You can search the Medicare Care Compare tool on Medicare.gov, or call Medicare at 1-800-MEDICARE. The nursing home itself can also tell you whether it is certified.
A facility certified for skilled nursing care may not be certified for all types of care. Some are certified only for short-term rehabilitation. Ask what services the facility is certified to provide and whether it can handle your specific medical needs.
If you move to a non-certified facility, Medicare will not pay anything, even if you meet all other requirements. You will be responsible for the full cost.
What happens when your 100 days run out
If you still need skilled care after 100 days, Medicare stops paying. At that point, you have three main options: pay privately, transition to Medicaid coverage (if you may have access to), or leave the facility.
Some people move to a different type of facility — such as a long-term acute care hospital or a residential care facility — that may have different payment rules. Others return home with home health services, which Medicare may cover if a doctor orders them and you are homebound. Talk to the nursing home's social worker about your options before day 100 approaches.
If you have Medicaid, it may cover skilled nursing care beyond 100 days, with no day limit. Medicaid rules vary by state, so contact your state Medicaid office to understand what you are covered for.
Medicaid coverage when Medicare ends
Medicaid is a joint federal and state program that covers nursing home care — both skilled and custodial — for people with low income and limited assets. Unlike Medicare, Medicaid has no day limit. If you may have access to, Medicaid can cover your stay indefinitely.
Medicaid rules differ by state. Some states cover nursing home care more generously than others. To learn whether you may have access to and what your state covers, contact your state Medicaid office or a local Area Agency on Aging.
Many people use Medicare first, then transition to Medicaid when Medicare coverage ends. The nursing home can help you understand whether you might may have access to and how to begin the process.
Frequently Asked Questions
Can Medicare cover a nursing home stay if I was not hospitalized first?
No. Medicare requires a three-day hospital stay before it will cover nursing home care. If your doctor recommends a nursing home but you have not been hospitalized, Medicare will not pay. You would need to pay privately or use Medicaid if you may have access to.
Does Medicare cover nursing home care for dementia or Alzheimer's disease?
Only if the care is skilled — for example, wound care or physical therapy related to the condition. If you need a nursing home only because you cannot care for yourself due to dementia, that is custodial care, and Medicare does not cover it. Medicaid may cover it if you may have access to.
What if I need nursing home care but do not have Medicare?
You would pay privately or turn to Medicaid if your income and assets are low enough. Some people have long-term care insurance that covers nursing home costs. Contact your state Medicaid office to learn whether you may have access to.
Can I stay in a nursing home longer than 100 days if I pay out of pocket?
Yes. Once Medicare coverage ends, you can remain in the facility and pay privately, or transition to Medicaid if you may have access to. The nursing home will work with you on payment arrangements or help you explore other options.
Does my Medigap plan cover nursing home costs after Medicare stops?
Some Medigap plans cover part of the daily copay during days 21 to 100. Few cover costs after day 100. Check your plan documents or call your insurance company to see what your specific plan covers in a nursing home.