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 in a hospital for at least three consecutive days, enter the nursing home within 30 days of hospital discharge, and need skilled nursing care (not just help with daily living). Even when you meet these conditions, Medicare pays the full cost for days 1–20, then requires you to pay a daily amount (called a coinsurance) for days 21–100. After day 100, you pay all costs yourself. This is called skilled nursing facility (SNF) care, and it is different from long-term residential care.
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. Medicare does not cover a nursing home stay if you do not meet the hospital requirement or if you need only custodial care — help with bathing, dressing, or meals without skilled medical services.
Key Takeaways
- Medicare covers nursing home care only after a hospital stay of at least three consecutive days, and only for skilled nursing care, not custodial care.
- Medicare pays the full cost for the first 20 days, then you pay a daily coinsurance amount for days 21–100, and you pay everything after day 100.
- Your doctor must order the nursing home care, and the facility must be Medicare-certified for your stay to be covered.
- If you need long-term residential care without skilled medical services, Medicare does not cover it; Medicaid, private pay, or long-term care insurance may help instead.
What "skilled nursing care" means and why it matters
Skilled nursing care means you need medical services that only a nurse or therapist can provide — wound care, intravenous medications, physical therapy after surgery, or monitoring for a serious condition. If you need help getting dressed or taking a bath but do not need these medical services, that is custodial care, and Medicare will not pay for it. The difference determines whether your nursing home stay is covered at all.
Your doctor decides whether you need skilled care. When you are discharged from the hospital, your discharge papers will say whether your doctor ordered skilled nursing facility care. If those papers do not mention it, Medicare will not cover a nursing home stay, even if you go to one. The nursing home itself must also be Medicare-certified — most are, but you should confirm before admission.
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 clock starts when you are admitted as an inpatient, not when you arrive at the emergency room. If you are in the hospital for observation only (not admitted as an inpatient), those days do not count, even if you stay three days or longer.
You must enter the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home later, Medicare will not cover it. Some people do not realize this rule until after they have already paid out of pocket for a few days. Ask your hospital discharge planner to confirm the dates before you leave.
How much you pay: the day-by-day breakdown
| Days in nursing home | What Medicare pays | What you pay |
|---|---|---|
| Days 1–20 | 100% of the cost | $0 |
| Days 21–100 | Most of the cost | Daily coinsurance (2024: $194.50) |
| Day 101 and beyond | $0 | 100% of the cost |
The daily coinsurance amount is one-quarter of the hospital deductible and changes each year. In 2024 it is $194.50, but you should confirm the current amount with your nursing home or by calling Medicare at 1-800-MEDICARE. Some people have supplemental insurance (Medigap) or Medicaid that covers part or all of the coinsurance; check your policy or contact your state Medicaid office to find out.
Medicare covers the nursing home's room, board, meals, and skilled nursing and therapy services. It does not cover private-duty nursing, phone service, television, or personal items. You are responsible for those costs.
When Medicare coverage ends
Medicare stops paying when one of three things happens: you no longer need skilled care (your doctor says you can manage at home), you have been there for 100 days, or your condition does not improve and your doctor determines further skilled care will not help. When Medicare coverage ends, the nursing home must notify you in writing at least two days before. You then have the right to appeal if you believe you still need skilled care.
If you run out of Medicare coverage but still need care, you will need to pay out of pocket, switch to Medicaid (if you meet income and asset limits), or rely on family support. Some nursing homes offer a lower rate if you transition from Medicare to private pay, though this is not may provide. Ask about this before you need it.
Medicaid coverage for long-term nursing home care
Medicaid is a joint federal and state program that covers long-term nursing home care if Medicare does not. Unlike Medicare, Medicaid covers custodial care and has no time limit — you can stay as long as you need it. However, Medicaid has strict income and asset limits that vary by state. In most states, your monthly income must be below a certain amount (often around $2,500 for a single person), and your assets must be below a limit (often around $2,000 for a single person, not counting your home).
If you have too much income or assets, you may need to "spend down" — use your money for care costs until you fall below the limit — before Medicaid will cover you. Some people plan for this years in advance by working with an elder law attorney. If you think you might need Medicaid, contact your state Medicaid office or a local Area Agency on Aging to learn your state's rules.
Private pay and long-term care insurance
If you do not meet Medicare or Medicaid requirements, you pay the nursing home directly. The cost varies widely by location and facility type, but nursing home care can cost $5,000 to $10,000 or more per month. Some people use savings, sell assets, or rely on family help. Others have long-term care insurance, a separate policy that covers nursing home, assisted living, or home care costs for a set period or amount.
Long-term care insurance is sold by private insurers and must be purchased before you need care. If you are already in a nursing home or have a diagnosis that would make you ineligible, you cannot buy it. If you are considering it, speak with an insurance agent or financial advisor about whether it makes sense for your situation.
Questions to ask your doctor and nursing home
Before you enter a nursing home, ask your doctor: "Will Medicare cover this stay, and for how long?" and "What type of care do I need — skilled or custodial?" Ask the nursing home: "Are you Medicare-certified?" and "What will I owe after Medicare coverage ends?" Get the answers in writing. Ask the discharge planner at the hospital to confirm the dates and the type of care ordered. These conversations now prevent confusion and bills later.
Frequently Asked Questions
Can I use Medicare to pay for a nursing home without a hospital stay first?
No. Medicare skilled nursing facility coverage requires a hospital stay of at least three consecutive days as an inpatient, and you must enter the nursing home within 30 days of discharge. If you go directly from home to a nursing home, Medicare will not cover it. You would need to pay privately or use Medicaid if you meet the income and asset limits.
What happens if I need to stay longer than 100 days?
After day 100, Medicare stops paying and you are responsible for all costs. You can stay in the nursing home if you pay out of pocket, or you may transition to Medicaid coverage if you meet your state's income and asset limits. Some nursing homes offer a reduced rate for private-pay residents; ask about this option.
Does Medicare cover nursing home care for rehabilitation after surgery?
Yes, if you had a hospital stay of at least three consecutive days and your doctor orders skilled nursing facility care. Rehabilitation after surgery is a common reason for Medicare-covered nursing home stays. Medicare will cover it as long as you continue to need skilled services and meet the time limits.
Will my supplemental insurance pay the daily coinsurance amount?
Some Medigap policies cover part or all of the daily coinsurance for days 21–100. Check your policy documents or call your insurance company to find out what your plan covers. If you do not have supplemental insurance, you pay the full coinsurance amount yourself unless you also have Medicaid.
How do I know if a nursing home is Medicare-certified?
You can search for Medicare-certified facilities on the Medicare.gov website under "Care Compare," or call your state health department. When you contact a nursing home, ask directly: "Are you Medicare-certified?" The facility should say yes and provide their certification number. If they are not certified, Medicare will not cover your stay there.