Most insurance does not pay for long-term nursing home care, but some covers short-term stays after a hospital visit
Insurance coverage for nursing homes depends almost entirely on why you need care and how long you will stay. Medicare covers up to 100 days of skilled nursing care after a hospital stay of at least three days — but only if you are recovering from an acute illness or injury, not from chronic conditions that need ongoing management. Private insurance rarely covers nursing home care at all. Medicaid, which is a state program, does cover long-term nursing home stays, but only after your savings fall below a certain limit and you meet other requirements.
The distinction matters because it changes what you pay and how quickly you need to plan. A three-week stay to recover from pneumonia after hospitalization looks completely different from a permanent move because of dementia.
Key Takeaways
- Medicare covers skilled nursing care for up to 100 days following a may have access to hospital stay, but not custodial care or long-term residence.
- Medicaid covers long-term nursing home care for people whose assets and income fall below state-set limits, and the rules vary by state.
- Private insurance policies almost never cover nursing home care unless they are long-term care insurance policies purchased specifically for that purpose.
- You pay out of pocket for any stay that does not meet Medicare's requirements or until Medicaid coverage begins.
- Planning ahead — including understanding your state's Medicaid rules and considering long-term care insurance — changes what options are available to you.
Medicare coverage for short-term skilled nursing care
Medicare Part A covers a nursing home stay only if three conditions are met: you spent at least three consecutive days in a hospital when ready before the nursing home admission, you are admitted to a Medicare-certified facility, and the care you need is skilled nursing care — meaning nursing or therapy services that require a licensed professional, not just help with daily activities.
Under these conditions, Medicare pays the full cost for days 1 through 20. From day 21 through day 100, you pay a daily coinsurance amount (in 2024, this is $200 per day, though the amount changes yearly). After day 100, you pay the entire cost yourself. The clock resets if you leave the nursing home for 60 consecutive days and then return to a hospital for another three-day stay.
This coverage does not extend to custodial care — help with bathing, dressing, eating, or toileting — unless it is part of a skilled nursing or therapy plan. If you need a nursing home only because you cannot manage daily activities on your own, Medicare does not pay.
Medicaid coverage for long-term nursing home residence
Medicaid is the program that actually pays for most long-term nursing home care in the United States. Unlike Medicare, which is federal and the same everywhere, Medicaid is run by each state and the rules vary significantly. Every state's Medicaid program covers nursing home care, but each state sets its own income and asset limits.
To be covered by Medicaid for a nursing home, you must meet two main requirements: your monthly income must fall below your state's limit (usually between $2,000 and $2,500, though this varies), and your countable assets must be below your state's limit (typically $2,000 for a single person, though some states allow more). Your home, one car, and certain personal items do not count toward the asset limit, but savings, investments, and other property do.
If your income or assets are above the limit, you must spend down your savings on nursing home care until you reach the threshold. This is called "spending down to Medicaid." Once you may have access to, Medicaid pays the nursing home directly, though you are usually required to contribute your monthly income toward the cost (you keep a small personal needs allowance).
Each state also has different rules about whether a spouse can keep a certain amount of assets and income while the other spouse is in a nursing home. Contact your state Medicaid office or a local Area Agency on Aging to learn your state's specific rules.
Private insurance and long-term care insurance
Standard health insurance — whether through an employer, the marketplace, or a private plan — does not cover nursing home care. These policies are designed for acute medical treatment, not ongoing residential care.
Long-term care insurance is a separate product you purchase specifically to cover nursing home stays, assisted living, or in-home care over months or years. If you bought a long-term care policy before entering a nursing home, it may pay a daily benefit toward your care. However, these policies are expensive, have waiting periods before coverage begins, and often have limits on how much they will pay or how long they will pay. Most people do not have long-term care insurance.
If you are considering long-term care insurance, you typically need to purchase it while you are still healthy and working, because insurers will not sell it to someone already diagnosed with a serious illness or cognitive decline.
What you pay out of pocket
If your stay does not meet Medicare's requirements, or if you have exhausted your Medicare coverage, you pay the full nursing home cost yourself until Medicaid coverage begins. Nursing home costs vary widely by location and facility type, but average between $7,000 and $10,000 per month for a semi-private room, with private rooms costing more.
If you are spending down to Medicaid, you will pay out of pocket until your assets reach your state's limit. Some families hire an elder law attorney to help structure this spending in a way that protects assets for a surviving spouse or preserves some funds for the other spouse's care. This is legal planning, not fraud, but the rules are complex and state-specific.
Once Medicaid covers you, the program pays the nursing home directly. You contribute your monthly income (minus a small personal needs allowance, usually $30 to $50 per month) toward the cost. Medicaid pays the difference.
Planning ahead to understand your coverage
Because coverage rules are different for short-term recovery versus long-term care, and because Medicaid rules vary by state, the time to learn what you might face is before you need a nursing home. If you are currently healthy, you can explore whether long-term care insurance makes sense for your situation. If you are already aging or managing a chronic condition, you can learn your state's Medicaid rules so you understand what happens if nursing home care becomes necessary.
An Area Agency on Aging can answer questions about your state's Medicaid rules and help you understand the spending-down process. An elder law attorney can explain how to structure your finances if you think you may need nursing home care within the next few years. These conversations cost far less than making decisions in crisis.
Questions to ask your doctor or social worker
If your doctor mentions that nursing home care might be in your future, ask whether the care you would need is skilled nursing care (which Medicare might cover for a short time) or custodial care (which it will not). Ask whether a hospital stay is likely to precede the nursing home admission, because that changes Medicare coverage. Ask for a referral to a social worker or discharge planner who can explain what your specific situation would cost and what coverage might be available.
If you are already in a nursing home or admitted to one, ask the facility's social worker or business office which insurance is being billed and what you will owe once that coverage ends. Do not assume the facility will tell you automatically — you have to ask.
Frequently Asked Questions
Will Medicare pay if I need a nursing home but was not in the hospital first?
No. Medicare only covers nursing home care if you had a may have access to hospital stay of at least three days when ready before admission. If you go directly from home to a nursing home, Medicare does not pay, even if you need skilled nursing care.
Can I keep my house if I am on Medicaid for nursing home care?
Yes. Your primary residence does not count toward Medicaid's asset limit in most states. However, some states can place a lien on your home after you die to recover what Medicaid paid for your care. Ask your state Medicaid office or an elder law attorney about your state's rules.
What happens if my spouse is in a nursing home on Medicaid and I am still at home?
Each state has different rules about how much income and assets a community spouse (the one still at home) can keep while the other spouse is on Medicaid. Some states allow the community spouse to keep a significant portion of joint assets. Contact your state Medicaid office to learn what applies to you.
If I have long-term care insurance, do I still need to worry about Medicaid?
It depends on how much your policy pays and for how long. If your policy's daily benefit is lower than the nursing home's actual cost, you will pay the difference out of pocket until your assets are low enough to may have access to for Medicaid. Review your policy to understand its limits and what happens when the benefit period ends.
Can I transfer money to my children to become poor enough for Medicaid?
Not without consequences. Medicaid has a five-year lookback period — if you gave away assets within five years of explore, Medicaid will penalize you by delaying coverage. An elder law attorney can explain what transfers are allowed and how to structure them legally if you are planning ahead.