Yes, Medicare covers some nursing home costs, 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, be admitted to 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 or dressing when no medical treatment is involved.
The nursing home itself must be Medicare-certified. Most nursing homes are, but you should confirm this before admission. Your doctor must also order the care, and a Medicare reviewer must agree that the services you need are medically necessary. If these conditions are not met, Medicare will not pay, and you or your family will be responsible for the full cost.
Key Takeaways
- Medicare covers skilled nursing facility care only after a hospital stay of at least three consecutive days, and only if admitted within 30 days of discharge.
- Medicare pays for medically necessary skilled care like wound care, physical therapy, or medication management — not for help with bathing or dressing alone.
- Medicare covers the first 20 days at 100 percent, days 21 through 100 with a daily copay that changes each year, and nothing after day 100 in a benefit period.
- The nursing home must be Medicare-certified, and your doctor's order plus Medicare's approval are required before coverage begins.
- If you do not meet the hospital-stay requirement or need only custodial care, Medicare will not pay, and Medicaid or private payment becomes your option.
What Medicare actually pays for in a nursing home
Medicare covers the cost of the room, meals, nursing care, medications, medical equipment, and therapy services — but only the skilled care portion. Skilled care means services that require a nurse or therapist: wound dressing, catheter care, physical therapy after a stroke, speech therapy, or intravenous medication. If you are in the nursing home only because you cannot bathe yourself or need help getting dressed, that is custodial care, and Medicare will not pay for it.
The line between skilled and custodial care is not always clear. A nurse helping you bathe after surgery while monitoring a surgical wound is skilled care. A nursing home aide helping you bathe because you have arthritis is custodial care. Medicare reviewers make this judgment, and they can decide mid-stay that you no longer need skilled care and stop paying. When that happens, you have the right to appeal, but you are responsible for costs while the appeal is pending.
How much Medicare pays and for how long
Medicare covers up to 100 days in a skilled nursing facility per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the nursing home with no hospital or nursing home stay in between. Here is how the payment breaks down:
| Days in nursing home | What Medicare pays | What you pay |
|---|---|---|
| Days 1–20 | 100 percent of costs | Nothing |
| Days 21–100 | All costs except a daily copay | Daily copay (amount changes yearly) |
| Day 101 and beyond | Nothing | Full cost of care |
The daily copay for days 21 through 100 is set each year and is one-eighth of the Medicare Part A hospital deductible. In 2024, that copay is $194 per day, but this amount changes annually. After day 100, you pay the entire bill unless you have a supplemental insurance policy or Medicaid covers you.
The three-day hospital stay requirement
You must spend at least three consecutive days in the hospital before Medicare will pay for nursing home care. The days must be as an inpatient — observation status does not count, even if you spent three calendar days in the hospital. This distinction matters: some hospitals place patients in observation rather than inpatient status to reduce costs, and if that happens to you, Medicare will not cover the nursing home stay that follows.
If you are unsure whether you were admitted as an inpatient or placed in observation, ask the hospital billing department or your discharge planner. You can also call Medicare at 1-800-MEDICARE. If you were in observation and believe the hospital made an error, you can file a complaint with the hospital's patient advocate or appeal to Medicare directly. The appeal process takes time, so do this as soon as you realize the issue.
When Medicare will not pay for nursing home care
Medicare will not pay if you do not meet the three-day hospital stay requirement, if you are admitted to the nursing home more than 30 days after hospital discharge, or if you need only custodial care. Medicare also will not pay if the nursing home is not Medicare-certified. Some smaller facilities, assisted living communities, and board-and-care homes are not certified, so confirm this before admission.
If Medicare stops paying before day 100 because reviewers decide you no longer need skilled care, you have the right to request a detailed explanation and to appeal. The nursing home must give you written notice at least two days before they stop billing Medicare. During the appeal, you may still be responsible for daily costs, so understand your options quickly.
What happens when Medicare coverage ends
When Medicare stops paying — either because you have used 100 days or because you no longer need skilled care — you must find another way to pay. Your options are Medicaid, a long-term care insurance policy, family payment, or leaving the nursing home. Medicaid covers nursing home care for people with low income and limited assets, but the rules vary by state. Some states cover custodial care; others do not. Some nursing homes accept Medicaid; others do not.
Before Medicare coverage ends, ask the nursing home's social worker or financial counselor about Medicaid coverage in your state and whether the facility accepts it. If you have a long-term care insurance policy, contact the insurance company to understand what it covers. If you plan to pay privately, confirm the cost with the nursing home in writing and understand whether the rate changes if your care needs change.
How to confirm Medicare will pay before admission
Before you or a family member is discharged from the hospital to a nursing home, ask the hospital discharge planner to confirm that Medicare will cover the nursing home stay. The planner should verify that you meet the three-day inpatient requirement, that the nursing home is Medicare-certified, and that your doctor has ordered skilled care. Ask for this confirmation in writing.
Once you are in the nursing home, Medicare sends you a notice called "Important Message About Your Rights" within two days of admission. This notice explains what Medicare will pay for, how long coverage will last, and what you can do if you disagree. Read it carefully and ask the nursing home staff to explain anything you do not understand. If you believe Medicare is making an error, you can appeal while you are still in the facility.
Frequently Asked Questions
Does Medicare cover assisted living or board-and-care homes?
No. Medicare only covers skilled nursing facilities that provide medical care under a doctor's order. Assisted living and board-and-care homes provide custodial care and activities of daily living support, which Medicare does not cover. Medicaid may cover some of these settings in some states, but rules vary widely.
What if I need nursing home care but was never hospitalized?
Medicare will not pay because you do not meet the three-day hospital stay requirement. You would need to pay privately, explore Medicaid coverage if you may have access to, or look for other community-based services like home health care or adult day programs that might meet your needs.
Can I appeal if Medicare stops paying before day 100?
Yes. You have the right to appeal if you believe you still need skilled care. The nursing home must notify you in writing at least two days before they stop billing Medicare. You can request an appeal through the nursing home or contact Medicare directly at 1-800-MEDICARE. During the appeal, you may be responsible for costs.
Does Medicare cover nursing home care after a fall at home?
Only if the fall led to a hospital admission of at least three consecutive days as an inpatient, and you are admitted to the nursing home within 30 days of discharge. If you went to the emergency room and were sent home without being admitted as an inpatient, Medicare will not cover nursing home care that follows.
What if the nursing home says it is not Medicare-certified?
Do not admit yourself or a family member there if Medicare coverage is expected. Call Medicare at 1-800-MEDICARE to find a certified facility nearby. You can also search the Medicare Care Compare tool on Medicare.gov to see which nursing homes in your area are certified and what their inspection records show.