Medicare covers some nursing home costs, but only under specific conditions and for a limited time
Medicare will pay for skilled nursing care in a nursing home, but only after you have been in a hospital for at least three days and only if you are admitted to the nursing home within 30 days of leaving the hospital. The care must be for the same condition you were treated for in the hospital, or a condition that developed during your hospital stay. Medicare pays the full cost of the first 20 days. From day 21 to day 100, you pay a daily amount (called a coinsurance) and Medicare covers the rest. After day 100 in the same benefit period, Medicare stops paying and you are responsible for all costs.
This is different from long-term custodial care, which is help with daily activities like bathing, dressing, and eating. Medicare does not cover custodial care in a nursing home, even if you need it for years. Many people confuse these two types of care and assume Medicare will pay for a nursing home stay when it will not.
Key Takeaways
- Medicare covers skilled nursing care only after a hospital stay of at least three days, and only for up to 100 days per benefit period.
- You must enter the nursing home within 30 days of leaving the hospital, and the care must relate to your hospital condition.
- Medicare pays all costs for days 1–20, but you pay a daily coinsurance from day 21–100.
- Medicare does not cover long-term custodial care, such as help with bathing or dressing, even if you need it permanently.
- Medicaid, not Medicare, is the program that covers long-term nursing home stays for people who meet income and asset limits.
What counts as skilled nursing care that Medicare will cover
Skilled nursing care means medical care that must be given by a nurse or under a nurse's supervision. Examples include wound care after surgery, intravenous (IV) medications, physical therapy ordered by your doctor, or monitoring of a new medical condition. The nursing home must be a Medicare-certified facility, which means it meets federal standards and has agreed to accept Medicare payment.
The key word is "skilled." If you are in a nursing home only because you need help getting dressed, taking medicine you can manage yourself, or eating meals, that is custodial care and Medicare will not pay for it. Your doctor must document that you need daily skilled care from a nurse or therapist, not just supervision or reminders.
How the 100-day limit works and what happens after
Medicare's nursing home benefit is measured in "benefit periods." A benefit period starts the day you enter the hospital and ends 60 days after you leave the nursing home without being readmitted. If you are readmitted to a hospital after leaving the nursing home, a new benefit period begins, and you get another 100 days of coverage — but only if you meet the three-day hospital stay requirement again.
Many people think they get 100 days per year. That is not how it works. You get 100 days per benefit period, and benefit periods are tied to hospital admissions. If you leave the nursing home and stay out of the hospital for 60 days, your benefit period ends and your 100-day count resets to zero. If you are readmitted to the hospital before those 60 days pass, you are still in the same benefit period and your 100-day count does not reset.
After day 100, you must pay the full cost of the nursing home yourself, unless you are covered by Medicaid or have a supplemental insurance policy that covers nursing home care.
Your costs during the first 100 days
For days 1 through 20, Medicare pays 100 percent of the cost of skilled nursing care. You pay nothing for the nursing home itself, though you are still responsible for any costs Medicare does not cover, such as phone, television, or personal items.
From day 21 through day 100, you pay a daily coinsurance amount. This amount changes each year. Your nursing home will tell you the exact amount when you are admitted. Medicare pays the rest of the cost. Some supplemental insurance policies (called Medigap plans) cover part or all of this coinsurance, so check your policy.
When Medicaid takes over for long-term care
Medicaid is a separate program from Medicare, run by your state, that covers long-term nursing home care for people with limited income and assets. Medicaid has no time limit — it can cover nursing home care for years or for life. However, Medicaid has strict rules about how much money and property you can own and still be covered. These rules vary by state.
Many people spend down their savings on nursing home care until they meet their state's Medicaid limits, then Medicaid takes over. This is a complex process, and the rules about what assets count and how fast you must spend them differ from state to state. A Medicaid planner or elder law attorney in your state can explain how this works where you live.
If you think you may need long-term nursing home care, it is worth understanding your state's Medicaid rules before a crisis forces you to make quick decisions.
How to know if a nursing home accepts Medicare
Before you choose a nursing home, ask whether it is Medicare-certified. You can also search the Medicare Care Compare tool on Medicare.gov, which lists all Medicare-certified nursing homes in your area and shows inspection results and staffing information. The nursing home's admission staff should be able to tell you when ready whether they accept Medicare and what their current census is for Medicare patients.
Not all nursing homes are Medicare-certified. Some are Medicaid-only, and some are private-pay only. If you are counting on Medicare to cover your stay, you must choose a certified facility.
What to ask your doctor and the nursing home before admission
Before you are discharged from the hospital to a nursing home, ask your doctor: "Will I need skilled nursing care after I leave the hospital, and for how long?" If the answer is no, Medicare will not cover a nursing home stay. Ask the hospital discharge planner which nursing homes are Medicare-certified and which ones have beds available.
When you contact the nursing home, ask: "Are you Medicare-certified?" "What is your daily coinsurance rate for days 21–100?" "What is not covered by Medicare?" and "Do you have a social worker who can help me understand my coverage?" Write down the answers and keep them with your hospital paperwork.
Frequently Asked Questions
Does Medicare cover nursing home care if I was not in the hospital first?
No. Medicare covers nursing home care only after a hospital stay of at least three days. If you go directly to a nursing home from home or from a doctor's office, Medicare will not pay for it, even if you need skilled care. You would need to pay privately or use Medicaid if you meet the income and asset limits.
What if I need to stay in the nursing home longer than 100 days?
After day 100, Medicare stops paying and you are responsible for the full cost. If you have a Medigap policy, check whether it covers nursing home care beyond 100 days — some do, some do not. If you cannot pay privately, you may be able to switch to Medicaid if your state covers nursing home care and you meet the financial limits.
Can I use my Medicare Advantage plan instead of Original Medicare for nursing home care?
Yes. Medicare Advantage plans must cover the same skilled nursing home benefit as Original Medicare — up to 100 days per benefit period after a three-day hospital stay. However, the nursing home must be in your plan's network, and you may have different coinsurance amounts. Call your plan before admission to confirm coverage and costs.
If I leave the nursing home and come back later, do I get another 100 days?
Only if you are readmitted to the hospital for at least three days before you return to the nursing home. If you leave the nursing home and stay out of the hospital for 60 days, your benefit period ends and a new one begins when you are next hospitalized. If you return to the nursing home without a new hospital stay, Medicare will not pay.
Does Medicare cover physical therapy or occupational therapy in a nursing home?
Yes, if it is ordered by your doctor as part of your skilled care and the nursing home is Medicare-certified. Therapy is covered under the same 100-day limit as other skilled nursing care. However, the nursing home must provide the therapy itself or contract with a therapist — you cannot arrange it privately and expect Medicare to pay.