Medicare covers some nursing home care, but only under specific conditions

Medicare will pay for a nursing home stay, but only if you meet strict requirements. You must have been in a hospital for at least three consecutive days, enter the nursing home within 30 days of leaving the hospital, and be admitted for a condition related to your hospital stay. The nursing home must also be Medicare-certified. If you do not meet these conditions, Medicare will not pay, and you will be responsible for the full cost.

The coverage is temporary. Medicare pays for up to 100 days in a skilled nursing facility (SNF) per benefit period, but your out-of-pocket costs rise sharply after day 20. Understanding these limits and what happens when they run out is essential for planning and avoiding surprise bills.

Key Takeaways

  • Medicare covers nursing home care only after a may have access to hospital stay of at least three consecutive days, and only if you enter the nursing home within 30 days.
  • Medicare pays the full cost of days 1 through 20, but you pay a daily coinsurance amount (currently $194.50 per day in 2024, though this changes yearly) for days 21 through 100.
  • After 100 days in a benefit period, Medicare coverage ends completely and you must pay all costs out of pocket or through Medicaid if you may have access to.
  • The nursing home must be Medicare-certified and provide skilled nursing or rehabilitation services, not just custodial care like help with bathing or dressing.
  • If you need nursing home care without a may have access to hospital stay, Medicare will not pay, and you will need to explore Medicaid, private insurance, or personal funds.

What counts as a may have access to hospital stay

The three-day rule is strict. You must spend three full calendar days as an inpatient in a hospital — not the emergency room, not observation status. The day you are admitted does not count; the count starts the next day. If you are admitted on a Monday and discharged on Wednesday, that is only two days and does not may have access to. You need to be admitted on Monday and discharged on Thursday or later.

Observation status is not the same as inpatient status. Many people spend time in a hospital on observation — meaning the hospital is watching you but has not formally admitted you as an inpatient. If your hospital stay was observation only, it does not count toward the three-day requirement, even if you were in the hospital for five days. Ask the hospital directly: "Am I an inpatient or on observation status?" The answer determines whether your nursing home care will be covered.

You must enter the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home two months later, Medicare will not pay for that nursing home stay, even if the condition is related to your hospital visit.

How much Medicare pays and for how long

Medicare covers the full cost of the first 20 days with no out-of-pocket expense to you. Starting on day 21, you pay a daily coinsurance amount. In 2024, this amount is $194.50 per day, but it changes each year. The nursing home bills Medicare for its share, and you are responsible for your share. This continues through day 100.

After day 100 in a benefit period, Medicare stops paying entirely. You then pay 100 percent of the nursing home bill. A benefit period runs from the day you enter the hospital until 60 days have passed with no hospital or skilled nursing facility stay. Once a new benefit period begins, you get another 100 days of coverage, but only if you meet the three-day hospital stay requirement again.

The daily coinsurance is separate from any other costs. If the nursing home charges extra for a private room, phone service, or other amenities, you pay those on top of the coinsurance. Ask the nursing home for an itemized list of what Medicare covers and what you will owe.

What type of care Medicare covers in a nursing home

Medicare covers skilled nursing care and skilled rehabilitation services only. Skilled care means services that must be performed or supervised by a nurse or therapist — wound care, injections, physical therapy, occupational therapy, or speech therapy. If you need help with bathing, dressing, eating, or toileting only, that is custodial care, and Medicare does not pay for it.

The nursing home must be a Medicare-certified skilled nursing facility. Not all nursing homes are certified. Before you are admitted, confirm that the facility is Medicare-certified. You can check the Medicare Care Compare website (Medicare.gov) or call Medicare at 1-800-MEDICARE to verify. If the facility is not certified, Medicare will not pay.

Your doctor must order the skilled care, and it must be medically necessary and related to the condition that sent you to the hospital. If you are admitted to a nursing home for a reason unrelated to your hospital stay, Medicare will not cover it, even if you had a may have access to hospital stay.

What happens when Medicare coverage ends

When you reach day 100 or when your coverage ends for another reason, the nursing home must notify you in writing before your coverage stops. You then have choices: pay out of pocket if you can afford it, explore Medicaid coverage if you meet income and asset limits, use a long-term care insurance policy if you have one, or discuss discharge planning with the nursing home social worker.

Medicaid is a state-run program that covers long-term nursing home care for people with limited income and assets. The income and asset limits vary by state. If you are approaching the end of your Medicare coverage, ask the nursing home social worker to help you understand whether you might may have access to for Medicaid in your state. Some people become Medicaid-may be able to access after spending down their savings on nursing home care.

Do not wait until day 100 to plan. Start conversations with the social worker around day 80 or 90 about what comes next. The nursing home cannot discharge you without a safe plan in place, but you need time to explore your options.

Questions to ask your doctor and the nursing home

Before you are admitted to a nursing home, ask your doctor: "Does my hospital stay meet Medicare's three-day inpatient requirement?" and "Is the nursing home care medically necessary and related to my hospital condition?" These answers determine whether Medicare will pay.

Ask the nursing home: "Are you Medicare-certified?" "What is your daily rate?" "What does Medicare cover, and what will I owe?" "How will you notify me when my 100 days are ending?" and "Can your social worker help me explore Medicaid if needed?" Get the answers in writing.

Ask the hospital before discharge: "Am I being admitted as an inpatient or placed on observation status?" If you are on observation, ask whether the hospital can change your status to inpatient if medically appropriate. This single question can determine whether your nursing home care is covered.

When to contact Medicare or seek help

Call Medicare at 1-800-MEDICARE if you receive a bill you believe Medicare should have paid, if you are unsure whether your hospital stay qualifies, or if the nursing home tells you coverage is ending and you do not understand why. Medicare can review your case and explain the decision.

Contact your State Health Insurance information Program (SHIP) if you need free help understanding your coverage or if you believe you have been wrongly denied. SHIP counselors are trained to review Medicare decisions and can advocate on your behalf. Find your state's SHIP by calling 1-877-839-2675 or visiting shiptalk.org.

If you are in the nursing home and believe you are being discharged improperly or without a safe plan, contact your state's long-term care ombudsman. This office investigates complaints about nursing homes and can intervene on your behalf. Call 1-855-500-3537 to find your state's ombudsman.

Frequently Asked Questions

Does Medicare cover a nursing home stay if I was never in the hospital?

No. Medicare requires a may have access to hospital stay of at least three consecutive days as an inpatient. If you enter a nursing home directly from home or from an outpatient setting, Medicare will not pay. You would need to explore Medicaid, private insurance, or personal funds to cover the cost.

What is the difference between observation status and inpatient status?

Inpatient status means the hospital has formally admitted you and you are staying overnight under the hospital's care. Observation status means the hospital is monitoring you but has not admitted you as an inpatient. Only inpatient days count toward Medicare's three-day requirement. Ask the hospital directly which status applies to you.

Can I use Medicare to pay for a nursing home after my 100 days run out?

No. After 100 days in a benefit period, Medicare coverage ends completely. You then pay out of pocket, explore Medicaid if you may have access to, use long-term care insurance if you have it, or work with the nursing home social worker on other options. Start planning around day 80 or 90.

If I need more than 100 days of care, can I get another 100 days in a new benefit period?

Only if you meet the requirements again: you must have a new hospital stay of at least three consecutive days as an inpatient, and you must enter the nursing home within 30 days of discharge. A new benefit period begins 60 days after you leave the hospital or nursing home. If you stay in the nursing home continuously, you do not get a new 100-day period.

What if the nursing home is not Medicare-certified?

Medicare will not pay. Before admission, confirm the facility is Medicare-certified by checking Medicare Care Compare at Medicare.gov or calling 1-800-MEDICARE. If you are already in a non-certified facility, you are responsible for the full bill and should discuss options with the social worker when ready.