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

Medicare will pay for a stay in a skilled nursing facility (SNF) — the formal name for a nursing home that provides medical care — but only if you meet strict requirements. You must have been hospitalized for at least three consecutive days, enter the nursing home within 30 days of leaving the hospital, and need daily skilled nursing or rehabilitation services. Medicare does not cover custodial care, which is help with daily activities like bathing, dressing, and eating when no medical treatment is involved.

The difference matters because many people enter nursing homes for custodial care alone. If that is what you need, Medicare will not pay, and you will need to cover costs through private funds, Medicaid, or long-term care insurance. Understanding which type of care you actually need is the first step to knowing what your costs will be.

Key Takeaways

  • Medicare covers skilled nursing facility care only after a hospital stay of at least three consecutive days, and only if you are admitted within 30 days of discharge.
  • Medicare pays the full cost of the first 20 days in a skilled nursing facility, then requires you to pay a daily copay for days 21 through 100.
  • Custodial care — help with bathing, dressing, and eating — is never covered by Medicare, even if you are in a nursing home.
  • Medicaid, not Medicare, is the program that covers long-term custodial nursing home care for people with limited income and assets.
  • You should ask your hospital discharge planner whether your condition qualifies for skilled nursing care before you are discharged.

What Medicare Part A actually pays for in a nursing home

Medicare Part A is hospital insurance, and it extends to cover skilled nursing facility care as a continuation of hospital treatment. For the first 20 days of your stay, Medicare pays 100 percent of the cost. From day 21 through day 100, you pay a daily copay (the amount changes each year) and Medicare covers the rest. After day 100, Medicare stops paying entirely, and you are responsible for all costs.

The care must be skilled care, meaning it requires a nurse or therapist to deliver it. Examples include wound care after surgery, intravenous medications, physical therapy after a stroke, or monitoring for complications from a recent procedure. If you are in a nursing home but do not need these services — if you are there only because you cannot live alone — Medicare will not pay.

Your doctor and the nursing home must document that your condition requires daily skilled services. The nursing home will assess you when you arrive and report to Medicare whether you meet the requirement. If Medicare disagrees that skilled care is medically necessary, it can deny payment even if you are in a nursing home bed.

The three-day hospital stay requirement

You must have been an inpatient in a hospital for at least three consecutive days before Medicare will pay for nursing home care. Observation status does not count — you must be admitted as an inpatient. This distinction is important because some people spend two or three days in the hospital under observation and then are discharged, believing they will may have access to for nursing home coverage. They do not.

The three days must be consecutive calendar days, including weekends and holidays. If you are admitted on a Monday and discharged on Wednesday, that counts as three days. You must then enter the nursing home within 30 days of your hospital discharge date. If you go home first and enter a nursing home 35 days later, Medicare will not cover it, even if your doctor says you need skilled care.

Before you leave the hospital, ask the discharge planner to confirm in writing that you have met the three-day inpatient requirement. This document protects you if there is a dispute later about whether your hospital stay counted.

The daily copay you will owe from day 21 onward

After Medicare pays for your first 20 days in full, you enter what is called the coinsurance period. From day 21 through day 100, you pay a daily amount and Medicare covers the rest. The daily copay amount is set by Medicare each year and changes on October 1. In 2024, the daily copay is $194.50, but you should confirm the current amount with the nursing home or your Medicare plan before you are admitted.

This copay is separate from any charges the nursing home adds for services Medicare does not cover, such as phone service, television, or private room upgrades. You are responsible for those costs in addition to the daily copay. Some people have supplemental insurance (Medigap) that covers part or all of the copay, so check your policy before you arrive.

After day 100, you pay the full cost of the nursing home stay. Medicare does not cover any part of it. This is why many people transition to Medicaid coverage after day 100 if they have limited income and assets, or they use private funds or long-term care insurance.

When Medicare stops paying and Medicaid takes over

Medicaid is a separate program from Medicare, and it covers long-term nursing home care for people with limited income and assets. Each state sets its own income and asset limits, so the rules vary. Generally, Medicaid will cover custodial care — the daily help with bathing, dressing, and eating — that Medicare never covers.

If you exhaust your Medicare coverage after 100 days and need to stay in the nursing home, you may be able to switch to Medicaid if you meet your state's financial limits. The nursing home's social worker can help you understand whether you may have access to and what paperwork you need to submit. The process takes time, so it is important to start it before your Medicare coverage ends.

Some people use a combination: Medicare pays for the first 100 days of skilled care, and then Medicaid takes over for ongoing custodial care. Others pay privately for as long as they can, then explore for Medicaid. The nursing home social worker can explain your state's specific rules and timelines.

What Medicare does not cover in a nursing home

Medicare does not cover custodial care, which is the most common reason people live in nursing homes long-term. Custodial care includes bathing, dressing, grooming, toileting, eating, and moving around. Even if a nurse is present in the building, if the care you need is custodial rather than skilled, Medicare will not pay.

Medicare also does not cover room and board — the cost of the bed, meals, and housekeeping — unless it is part of a covered skilled nursing stay. Private rooms, television, phone service, and personal care items are your responsibility. Some nursing homes bundle these costs into one daily rate, and some bill them separately, so ask for an itemized cost breakdown before you are admitted.

If you need ongoing physical therapy or occupational therapy but do not need skilled nursing care, Medicare Part B (medical insurance) may cover the therapy if you receive it in an outpatient setting. It will not cover therapy in a nursing home unless you are also receiving skilled nursing care that qualifies for Part A coverage.

Questions to ask before you are discharged from the hospital

Before you leave the hospital, have a conversation with your discharge planner about whether your condition qualifies for skilled nursing facility care. Ask them to put the answer in writing and to confirm that you have met the three-day inpatient requirement. Ask which nursing homes in your area accept Medicare and which ones have beds available.

Ask the discharge planner how many days of skilled care Medicare is likely to cover based on your condition. This is an estimate, not a may provide — Medicare makes the final decision — but it helps you plan. Ask whether your supplemental insurance (if you have it) covers the daily copay after day 20.

If you are concerned about costs after day 100, ask the social worker about Medicaid in your state and whether you should start the process before you are discharged. Some hospitals have financial counselors who can walk you through these questions. Do not wait until you are home to ask — the hospital has access to your medical records and can give you the most accurate information.

Frequently Asked Questions

Does Medicare cover nursing home care if I did not have a hospital stay first?

No. Medicare Part A covers skilled nursing facility care only as a continuation of hospital treatment. If you enter a nursing home directly from home or from a doctor's office, Medicare will not pay, even if you need skilled care. You would need to pay privately, use Medicaid if you may have access to, or use long-term care insurance.

What happens if Medicare says I do not need skilled care after I am already in the nursing home?

Medicare can deny payment if it determines that your condition does not require daily skilled services. If this happens, you become responsible for all costs from that point forward. You can appeal the decision, and the nursing home social worker can help you file an appeal. Ask the nursing home to notify you when ready if Medicare denies coverage so you have time to arrange payment or explore Medicaid.

Can I use my Medicare Advantage plan instead of Original Medicare to pay for nursing home care?

Yes. Medicare Advantage plans (Part C) must cover skilled nursing facility care under the same rules as Original Medicare — three-day hospital stay, within 30 days, daily skilled care required. However, some Advantage plans have additional requirements, such as using in-network facilities. Contact your plan before you are discharged to confirm which nursing homes are covered and what your copay will be.

If I run out of Medicare coverage after 100 days, can I go back to Medicare later?

Only if you have another may have access to hospital stay. If you leave the nursing home and are hospitalized again for at least three days, you can return to a nursing home and start a new Medicare benefit period. The new stay is treated as a separate claim, and you get another 100 days of coverage. This does not happen automatically — you must meet the three-day requirement again.

Does Medicare cover nursing home care for rehabilitation after surgery?

Yes, if you meet the requirements. If you have surgery, spend at least three days in the hospital as an inpatient, and are discharged to a nursing home for physical therapy or occupational therapy, Medicare Part A will cover the skilled nursing facility care. This is one of the most common reasons Medicare covers nursing home stays — recovery from joint replacement, stroke, or other procedures requiring intensive rehabilitation.