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 not the way many people think. It does not cover custodial care — help with daily tasks like bathing, dressing, and eating — which is what most long-term residents need. Medicare only covers skilled nursing care, which means medical treatment that requires a nurse or therapist: wound care, physical therapy after surgery, medication management, or monitoring of a serious condition. The difference matters because it determines whether you pay nothing, pay part of the cost, or pay all of it yourself.

The other major limit is time. Medicare covers up to 100 days in a benefit period, and only if you meet strict entry requirements. Most people who enter a nursing home for long-term care will exhaust Medicare coverage well before they need to leave, which is why understanding what comes next — Medicaid, private pay, or a combination — is just as important as understanding what Medicare covers now.

Key Takeaways

  • Medicare covers skilled nursing care (medical treatment by nurses or therapists) but not custodial care (help with bathing, dressing, eating), which is what most long-term residents receive.
  • You must be admitted to the nursing home within one day of a hospital stay of at least three days, and a doctor must order the care you receive there.
  • Medicare pays all costs for days 1–20, then you pay a daily coinsurance amount (which varies yearly) for days 21–100; after day 100, you pay all costs yourself.
  • Once your 100 days end, Medicaid may cover ongoing care if you meet income and asset limits, but rules vary significantly by state.
  • Many people transition to private pay or Medicaid after Medicare coverage ends, so planning ahead with your family and the nursing home is essential.

The three-day hospital stay requirement

To may have access to for Medicare nursing home coverage, you must have been admitted to a hospital for at least three consecutive days before entering the nursing home. The clock starts when you are admitted as an inpatient — not when you arrive at the emergency room or when you are under observation. This is a common source of confusion: observation stays do not count toward the three-day requirement, even if you spend three days in the hospital.

You must then enter the nursing home within one day of leaving the hospital (or within three days if you go to a rehabilitation facility first). The nursing home must be one that Medicare recognizes, and your doctor must order skilled nursing care as part of your treatment plan. If you go home after your hospital stay and return to the nursing home later, you do not may have access to for Medicare coverage — you would need a new three-day hospital stay to restart the benefit.

How much Medicare pays and what you pay

Medicare covers the full cost of skilled nursing care for the first 20 days with no out-of-pocket expense to you. Starting on day 21, you pay a daily coinsurance amount while Medicare covers the rest. That coinsurance amount changes each year; you can find the current amount on Medicare.gov or by calling 1-800-MEDICARE. For 2024, the daily coinsurance is $200, but confirm the current figure before you or a family member enters a facility.

After day 100, Medicare stops paying entirely. At that point, you are responsible for the full cost of the nursing home, which averages between $8,000 and $12,000 per month depending on your location and the level of care — though costs vary widely. This is where many families discover they need to explore Medicaid, spend down savings, or arrange private payment.

What "skilled nursing care" actually means

Medicare only pays for care that requires the skills of a licensed nurse or therapist. This includes wound care after surgery, intravenous medications, physical therapy to regain strength after a stroke, speech therapy, occupational therapy, catheter management, and monitoring of conditions like heart failure or diabetes that need frequent medical assessment. It also includes care ordered by a doctor as part of a treatment plan — not just any nursing task, but one that is medically necessary and documented.

Custodial care — the majority of what nursing home residents receive — is not covered. This includes bathing, dressing, toileting, eating, grooming, and general supervision. If you need a nursing home primarily because you cannot manage these tasks safely on your own, Medicare will not pay. Many people need both skilled and custodial care; Medicare pays only for the skilled portion, and you or another payer (Medicaid, private insurance, or your own funds) must cover the custodial part.

When Medicare coverage ends and what happens next

Once you have used your 100 days, Medicare coverage stops. At that point, you have several options, and the right one depends on your income, assets, and the state where you live. Medicaid is the most common next step for people with limited income and assets; it covers both skilled and custodial nursing home care with no time limit. However, Medicaid has strict financial limits, and rules vary by state — some states are more generous than others. You can contact your state Medicaid office or a local Area Agency on Aging to learn whether you may be may be able to access.

Private pay means you or your family covers the cost directly from savings, income, or long-term care insurance. Some people use a combination: they spend down their savings to Medicaid limits while Medicaid gradually takes over payment. This is called "spend-down" and is legal, but the rules are complex and vary by state. A social worker at the nursing home or a legal advisor can help you understand your options.

If you have long-term care insurance, check your policy now — before you need it — to see what it covers and what the daily benefit is. Some policies cover nursing home care, some cover only home care, and some have waiting periods or limits on how long they pay. Knowing this in advance helps you plan.

How to verify a nursing home accepts Medicare

Not all nursing homes accept Medicare, and not all that do accept it for all types of care. Before you or a family member is discharged from the hospital, ask the discharge planner whether the nursing home you are considering is Medicare-certified. You can also search Medicare.gov's Nursing Home Compare tool, which lists every Medicare-certified facility in the country, shows inspection results, staffing levels, and whether it has been cited for violations.

Call the nursing home directly and confirm that it accepts Medicare for your specific type of care. Some facilities accept Medicare for rehabilitation after surgery but not for other conditions. Get this in writing if possible, and ask the nursing home to submit the Medicare paperwork on your behalf — they handle most of the administrative work, not you.

Planning ahead: questions to ask now

If you or a family member may need nursing home care in the future, start gathering information now. Ask your doctor what type of care you might need and for how long. Talk to a financial advisor or elder law attorney about whether long-term care insurance makes sense for your situation, and review any existing policies. Look up your state's Medicaid rules for nursing home coverage, because they differ from state to state and affect your planning.

If you are already in a nursing home or facing admission soon, ask the social worker or discharge planner to walk you through the Medicare coverage timeline and what happens when it ends. Many nursing homes have financial counselors who can explain your options and help you understand what you will owe. Having this conversation early — before you are in crisis — gives you time to make informed decisions with your family.

Frequently Asked Questions

Does Medicare cover the cost of the nursing home room and board?

No. Medicare covers only the skilled nursing care and therapy services you receive — the medical treatment. It does not cover room, board, meals, or activities. The nursing home bills you or another payer (Medicaid, insurance, or your own funds) for those costs separately, even during the days when Medicare is paying for your care.

What if I need nursing home care but did not have a three-day hospital stay?

Medicare will not pay. You would need to cover the cost through Medicaid (if you meet income and asset limits), private pay, long-term care insurance, or a combination. Some people enter a nursing home as private-pay residents and later transition to Medicaid once they spend down their savings to the Medicaid limit.

Can I use Medicare to pay for a nursing home if I just need help with daily tasks?

No. Medicare only covers skilled nursing care ordered by a doctor as part of a medical treatment plan. If you need help with bathing, dressing, eating, or other daily tasks but do not need medical treatment, Medicare does not pay. Medicaid may cover this type of custodial care if you meet financial limits.

What happens if I run out of Medicare coverage before I am ready to leave?

You become responsible for paying the full cost of the nursing home yourself. Many people transition to Medicaid at this point if they meet income and asset limits. The nursing home's social worker can help you understand whether you may be may be able to access and what the process process looks like in your state.

Does my Medigap or Medicare Advantage plan cover nursing home costs?

Most Medigap plans do not cover nursing home costs beyond what Original Medicare covers. Some Medicare Advantage plans offer additional benefits like limited nursing home coverage, but you need to check your specific plan. Call the plan directly or review your plan documents to see what is included.