Medicare covers some nursing home care, but only under specific conditions and only for a limited time

Medicare will pay for skilled nursing care after a hospital stay, but it does not cover long-term custodial care — the day-to-day help with bathing, dressing, and meals that most people need in a nursing home. If you need nursing home care for more than 100 days, or if you were not hospitalized first, Medicare stops paying and you become responsible for the full cost.

The difference matters because it determines who pays and for how long. A three-week stay after hip surgery is covered. A two-year stay because you can no longer live alone is not. Understanding which type of care you need — and which type Medicare will fund — changes everything about how you plan and pay.

Key Takeaways

  • Medicare covers up to 100 days of skilled nursing care per benefit period, but only if you were hospitalized for at least three consecutive days first.
  • You pay nothing for days 1 through 20, a daily copay for days 21 through 100, and the full cost after day 100.
  • Medicare does not cover custodial care — help with activities like bathing and dressing — even in a nursing home, and this is what most long-term residents need.
  • If you need nursing home care without a hospital stay, or need care beyond 100 days, Medicaid, private pay, or long-term care insurance are the main options.
  • The nursing home must be Medicare-certified and your doctor must order the care for Medicare to pay anything at all.

What Medicare will pay for in a nursing home

Medicare covers skilled nursing care — medical services that require a nurse or therapist, such as wound care, injections, physical therapy, or monitoring after surgery. It also covers room, board, and basic supplies during your stay. The facility must be Medicare-certified, your doctor must order the care, and you must have been admitted to a hospital for at least three consecutive days in the 30 days before entering the nursing home.

The coverage period is called a benefit period. It begins the day you enter the nursing home and ends when you have been out of the hospital or nursing home for 60 consecutive days. If you return to a nursing home after that 60-day gap, a new benefit period starts and your 100-day clock resets.

Your out-of-pocket costs depend on how long you stay. Days 1 through 20 are fully covered by Medicare. For days 21 through 100, you pay a daily copay (in 2024, this is $194 per day, though the amount changes each year). After day 100, you pay the entire cost yourself.

What Medicare does not cover in a nursing home

Medicare does not pay for custodial care — help with daily living activities such as bathing, dressing, toileting, eating, and moving around. It also does not cover room and board if you are receiving only custodial care, even if you live in a nursing home. This is the type of care most people need when they can no longer live alone, and it is the most expensive part of long-term nursing home stays.

Medicare also will not pay if you did not have a may have access to hospital stay first. If your doctor sends you directly from home or from an outpatient clinic to a nursing home, Medicare covers nothing. You must have been an inpatient in a hospital for at least three consecutive days — and those days must have included at least one overnight stay — within the 30 days before you enter the nursing home.

Additionally, Medicare does not cover stays at facilities that are not Medicare-certified. Before you or a family member enters a nursing home, ask the facility whether it is certified by Medicare and whether your doctor's orders meet Medicare's requirements for skilled care.

How the daily copay works for days 21 through 100

If your stay extends past day 20, you begin paying a copay for each day you remain. This copay is set by Medicare each year and applies to all Medicare beneficiaries. You pay this amount directly to the nursing home, not to Medicare. The nursing home bills Medicare for the rest of the cost.

The copay covers your entire stay — room, board, meals, nursing care, therapy, and supplies. There is no separate charge for individual services. If you have supplemental insurance (often called Medigap), it may cover some or all of this copay, depending on your plan. Check your policy or call your supplemental insurance company to find out what they cover.

If you stay the full 100 days, your total out-of-pocket cost for the copay portion is 80 days multiplied by the daily rate. After day 100, you owe the full daily cost of the nursing home, which varies widely by facility and location but often ranges from $200 to $400 or more per day.

When Medicare coverage ends and what happens next

Medicare stops paying after 100 days in a single benefit period. At that point, you must find another way to pay: Medicaid, private funds, long-term care insurance, or a combination of these. Some people return home or to assisted living when Medicare coverage ends. Others stay in the nursing home and switch to Medicaid if they meet income and asset limits.

Medicaid is a joint federal and state program that covers long-term nursing home care for people with limited income and assets. Unlike Medicare, Medicaid has no time limit — it can pay for years of care. However, Medicaid rules vary by state, and you must meet strict financial thresholds. In most states, you cannot have more than $2,000 in countable assets (the limit is higher for married couples). Medicaid also pays a lower daily rate than private pay, so not all nursing homes accept it.

If you have long-term care insurance, your policy may begin paying when Medicare ends, depending on what you purchased. Review your policy documents or call your insurance company to understand when benefits start and how much they cover per day.

If you have no insurance and cannot afford private pay, talk to the nursing home's social worker or financial counselor. They can explain Medicaid options in your state and help you understand what assets you may need to spend down to become Medicaid-may be able to access.

Questions to ask your doctor and the nursing home

Before you or a family member enters a nursing home, ask your doctor whether the care ordered qualifies as skilled nursing under Medicare rules. Ask specifically: "Will Medicare cover this stay?" and "For how many days?" Your doctor may not know the answer, so ask them to contact the nursing home's Medicare coordinator to confirm.

Ask the nursing home whether it is Medicare-certified and whether it accepts your insurance. Ask what your out-of-pocket costs will be for the first 20 days, days 21 through 100, and beyond day 100. Ask whether they accept Medicaid and, if so, whether they will continue your care if you transition from Medicare to Medicaid. Ask what happens if your doctor determines you no longer need skilled care before day 100 — Medicare coverage would end, and you would owe the copay or full cost from that point forward.

Ask whether the facility has a social worker or financial counselor who can explain payment options and help you plan for what comes after Medicare coverage ends.

When to contact Medicare or seek help understanding your coverage

If you receive a bill from a nursing home that you believe Medicare should have covered, contact Medicare at 1-800-MEDICARE (1-800-633-4227). You can also view your coverage details in your Medicare account online at Medicare.gov. If you have a Medicare Advantage plan instead of Original Medicare, call the plan directly — coverage rules may differ.

If you are struggling to understand your options or cannot afford care after Medicare coverage ends, contact your local Area Agency on Aging. They can connect you with counselors who understand Medicare, Medicaid, and other programs in your state. You can find your local agency at Eldercare Locator (1-800-677-1116) or online at Eldercare.acl.gov.

If you believe a nursing home is billing you incorrectly or refusing to accept Medicare, you can file a complaint with your state's Department of Health or the Centers for Medicare & Medicaid Services (CMS). The nursing home's admission paperwork should include information about how to file a complaint.

Frequently Asked Questions

Does Medicare cover nursing home care if I was not in the hospital first?

No. Medicare requires a hospital stay of at least three consecutive days within the 30 days before you enter the nursing home. If your doctor sends you directly from home or an outpatient clinic to a nursing home, Medicare will not pay. You would need to pay privately, use Medicaid if you may have access to, or use long-term care insurance.

What if I need to stay longer than 100 days?

Medicare stops paying after 100 days in a benefit period. After that, you pay the full cost unless you have Medicaid, long-term care insurance, or private funds. Medicaid can cover long-term stays if you meet income and asset limits in your state. Talk to the nursing home's social worker about your options.

Does my Medigap or Medicare Advantage plan cover the nursing home copay?

Some Medigap plans cover part or all of the daily copay for days 21 through 100. Medicare Advantage plans vary widely. Check your policy documents or call your insurance company to find out what they cover. The nursing home's billing department can also help you understand your coverage.

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

No. Medicare only covers skilled nursing care — medical services that require a nurse or therapist. Help with bathing, dressing, meals, and toileting (custodial care) is not covered by Medicare, even in a nursing home. You would need to pay privately or use Medicaid if you may have access to.

What happens to my Medicare coverage if I improve and leave the nursing home before day 100?

Your benefit period ends when you leave. If you return to a nursing home after being out for 60 consecutive days, a new benefit period begins and your 100-day clock resets. If you return within 60 days, you continue using the same benefit period and your remaining days.