Medicare covers some nursing home costs, but only under specific conditions and for a limited time
Medicare will pay for a nursing home stay, but only if you meet strict requirements: you must have been admitted to a hospital for at least three consecutive days (not counting the day you leave), be admitted to the nursing home within 30 days of hospital discharge, and need skilled nursing or rehabilitation care — not just help with daily living. Even when you meet these conditions, Medicare pays the full cost for the first 20 days, then requires you to pay a daily amount (called a coinsurance) for days 21 through 100. After 100 days in a benefit period, Medicare stops paying entirely.
The daily coinsurance amount changes each year. In 2024, you pay $194.50 per day for days 21–100, though this figure varies by year. If you stay longer than 100 days, you or your family must cover the remaining costs through savings, insurance, or other programs like Medicaid.
Key Takeaways
- Medicare pays for nursing home care only after a hospital stay of at least three consecutive days, and only if you enter the nursing home within 30 days of leaving the hospital.
- Medicare covers the full cost for the first 20 days, then you pay a daily coinsurance amount for days 21 through 100.
- After 100 days in a benefit period, Medicare stops paying and you must cover all costs yourself.
- The nursing home must be Medicare-certified, and your doctor must order skilled nursing or rehabilitation care — not custodial care or information with daily activities alone.
- Medicaid may cover costs Medicare does not, but Medicaid rules and coverage vary significantly by state.
What "skilled nursing care" means and why it matters
Medicare only pays for skilled nursing care or rehabilitation services, not for help with bathing, dressing, meals, or other daily activities. Skilled care means you need medical treatment or therapy that must be provided or supervised by a nurse or therapist — wound care, physical therapy after a hip replacement, medication management for a complex condition, or intravenous feeding, for example.
Your doctor must order this care in writing, and a Medicare-certified nursing home must agree that you need it. If you are admitted to a nursing home primarily because you cannot live alone and need help with daily tasks, Medicare will not pay, even if nurses are on staff. This distinction is the most common reason Medicare denies payment.
The three-day hospital stay requirement
You must spend at least three consecutive days in a hospital before Medicare will cover nursing home care. The day you are discharged does not count toward the three days. So if you are admitted on Monday and discharged on Thursday, that counts as three days (Monday, Tuesday, Wednesday). Observation stays — when the hospital admits you for monitoring but does not formally admit you as an inpatient — do not count, even if you spend three calendar days in the hospital.
This rule trips up many people. If your doctor sends you to the hospital for observation and then to a nursing home, Medicare will not pay for the nursing home stay because observation does not meet the three-day requirement. Ask the hospital directly whether you are being admitted as an inpatient or held for observation; the difference determines whether Medicare will later cover nursing home costs.
The 30-day window and benefit periods
You must enter the nursing home within 30 days of your hospital discharge. If you are discharged on a Monday and do not enter a nursing home until 35 days later, Medicare will not pay. This window is firm.
Medicare also organizes payment into benefit periods. A benefit period begins the day you enter a hospital or nursing home and ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. If you leave a nursing home, stay home for 60 days, then return to a nursing home, a new benefit period starts and your 100-day clock resets. If you return before 60 days have passed, you continue using the same benefit period and your remaining days from the previous stay.
What you pay: the daily coinsurance amount
For days 1 through 20, Medicare covers 100 percent of the cost of a Medicare-certified nursing home (room, board, meals, nursing care, therapy, and medications). You pay nothing during these 20 days, though you may still owe your hospital deductible if you have not met it for the year.
For days 21 through 100, you pay a daily coinsurance amount. In 2024, this amount is $194.50 per day, but it increases each year. The nursing home bills Medicare for the remainder. After day 100 in a benefit period, Medicare pays nothing and you are responsible for the full daily cost of the nursing home, which typically ranges from $100 to $300 or more per day depending on the facility and your location.
How Medicaid fills the gap when Medicare stops
Medicaid is a joint federal and state program that covers nursing home costs when Medicare does not. Unlike Medicare, Medicaid does not require a hospital stay first, and it covers custodial care (help with daily living) as well as skilled care. Medicaid also has no 100-day limit — it can pay for years of nursing home care if you meet income and asset limits.
However, Medicaid rules vary by state. Some states cover nursing home care generously; others have long waiting lists or stricter rules about which facilities they pay. To learn what Medicaid covers in your state, contact your state Medicaid office or call 211 and ask for a Medicaid specialist. Many people use Medicare first (the 100 days), then switch to Medicaid when Medicare stops paying.
Medicaid also requires you to spend down your savings to a certain level before it will pay. The asset limit varies by state but is often around $2,000 to $3,000. If you have more than this, you must use your own money for nursing home care until you reach the limit. Planning ahead with an elder law attorney can help you understand how to manage assets while preserving some for your care.
Medicare-certified nursing homes and how to verify one
Medicare only pays for care at a Medicare-certified nursing home. Not all nursing homes are certified. Before you or a family member enters a facility, confirm that it is Medicare-certified by visiting Medicare.gov and using the Nursing Home Compare tool, or by calling the nursing home directly and asking for its Medicare certification number.
The Nursing Home Compare tool also shows inspection reports, staffing levels, and complaints filed against each facility. This information is free and public. If a nursing home is not Medicare-certified and you need Medicare to pay, you will have to transfer to a certified facility or pay out of pocket.
Frequently Asked Questions
Does Medicare pay for a nursing home after an emergency room visit?
No. An emergency room visit does not count as a hospital admission. You must be formally admitted to the hospital as an inpatient for at least three consecutive days. If the ER sends you home or to observation, Medicare will not cover a nursing home stay afterward. Ask the hospital whether you are being admitted as an inpatient before you leave.
What happens if I need to stay in a nursing home longer than 100 days?
Medicare stops paying after 100 days in a benefit period. You then pay the full daily cost yourself, or you may turn to Medicaid if you meet your state's income and asset limits. Some people have long-term care insurance that covers costs after Medicare stops. Check your insurance policy or speak with a social worker at the nursing home about payment options.
Can I use Medicare to pay for a nursing home if I was never in a hospital?
No. Medicare requires a hospital stay of at least three consecutive days before it will cover nursing home care. If you need nursing home care but have not been hospitalized, you must pay out of pocket or use Medicaid if you meet the requirements. Medicaid does not require a hospital stay first.
If I leave a nursing home and come back, do I start over with the 100 days?
It depends on how long you were away. If you are out of a hospital or nursing home for 60 consecutive days or more, a new benefit period begins and your 100-day clock resets. If you return within 60 days, you continue the same benefit period and use only the remaining days from your previous stay.
Does Medicare pay for a private room in a nursing home?
Medicare covers a semi-private room (shared with one other patient). If you choose a private room, Medicare pays the semi-private rate and you pay the difference. The nursing home must tell you this cost upfront before you agree to a private room.