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

Medicare will pay for a nursing home stay, but not the way most people think. It does not cover custodial care — the help with daily living that most nursing home residents need long-term. Medicare covers skilled nursing care, which means medical treatment that requires a nurse or therapist: wound care after surgery, physical therapy, IV medications, or monitoring after a hospital stay. The stay must follow a hospital admission, last no more than 100 days, and meet Medicare's definition of "medically necessary."

If you need a nursing home for help with bathing, dressing, meals, or toileting — even if you cannot do these things alone — Medicare does not pay. That is custodial care, and it is the reason most people end up in nursing homes. Medicaid, not Medicare, covers custodial care, but only if your income and assets fall below your state's limits.

Key Takeaways

  • Medicare covers skilled nursing care for up to 100 days after a hospital stay of at least three nights, but only if the care is medically necessary.
  • You pay nothing for days 1–20, a daily copay (currently $194.50 per day in 2024, though this changes yearly) for days 21–100, and all costs after day 100.
  • Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting — which is what most nursing home residents need.
  • If you need long-term custodial care, Medicaid is the program that pays, but you must meet income and asset limits that vary by state.
  • The nursing home must be Medicare-certified and your doctor must order the care; you cannot choose a nursing home and then ask Medicare to pay.

What Medicare Pays For in a Nursing Home

Medicare covers skilled nursing facility (SNF) care — the medical services a nursing home provides. This includes wound dressing after surgery, physical or occupational therapy, speech therapy, catheter care, tube feeding, oxygen therapy, and medications given by a nurse. It also covers the room, meals, and basic supplies while you receive this skilled care.

The care must be ordered by your doctor and must be a direct result of a hospital stay. You cannot go straight from home to a nursing home and have Medicare pay. You must have been admitted to a hospital as an inpatient (not just the emergency room) for at least three consecutive nights, and you must move to the nursing home within 30 days of leaving the hospital.

The nursing home must be Medicare-certified. Most nursing homes are, but not all. Before discharge from the hospital, ask the discharge planner whether the facility you are considering accepts Medicare. If it does not, Medicare will not pay even if you meet all other requirements.

How Much You Pay Out of Pocket

Your costs depend on which days of your stay you are in the nursing home. Days 1 through 20 are fully covered by Medicare — you pay nothing except what you normally pay for Medicare (premiums, deductibles). Starting on day 21, you pay a daily copay. In 2024, that copay is $194.50 per day, but this amount changes each year.

After day 100, Medicare pays nothing. You are responsible for all costs from that point forward. Some people use long-term care insurance or Medicaid to cover days 101 onward, but Medicare's coverage ends at day 100.

Your Medicare Part A deductible applies to the stay. In 2024, that deductible is $1,632 per benefit period. If you have already met your Part A deductible earlier in the year (for example, during a hospital stay), you do not pay it again for the nursing home.

When Medicare Will Not Pay

Medicare will not pay if you did not spend at least three nights in a hospital first. An emergency room visit, observation stay, or outpatient procedure does not count. You must be formally admitted as an inpatient.

Medicare will not pay if the nursing home care is custodial rather than skilled. If you need help with activities of daily living but do not need medical treatment, Medicare does not cover it. A nursing home social worker or your doctor can tell you whether your care is classified as skilled or custodial, but Medicare makes the final decision.

Medicare will not pay if you move to the nursing home more than 30 days after leaving the hospital. The clock starts the day you are discharged from the hospital.

Medicare will not pay if the nursing home is not Medicare-certified. Some facilities specialize in custodial care and do not maintain Medicare certification. Others may have lost certification. Always confirm before admission.

The Difference Between Medicare and Medicaid Coverage

Medicare is a federal health insurance program for people 65 and older (and some younger people with disabilities). It covers skilled nursing care for up to 100 days after a hospital stay. It does not cover custodial care or long-term stays.

Medicaid is a joint federal-state program for people with low income and limited assets. It covers custodial care in a nursing home for as long as you need it, with no day limit. However, you must meet your state's income and asset limits. These limits vary widely — some states allow $2,000 in assets, others allow more. Some states count a spouse's income differently. You need to check your state's specific rules.

Many people use Medicare first (for the skilled care period after a hospital stay) and then transition to Medicaid (for ongoing custodial care) once Medicare's 100 days end. This is common and expected. The nursing home's social worker can help you understand how to move from one program to the other.

What to Do Before Entering a Nursing Home

Before you are discharged from the hospital, ask the discharge planner three things: Is the nursing home Medicare-certified? Will my care be classified as skilled or custodial? How many days does Medicare expect to cover?

Get the answers in writing if possible. The discharge planner should give you a document called a "Notice of Discharge and Detailed Explanation of Benefits" (sometimes called a "Detailed Explanation of Benefits" or DEB). This document tells you how many days Medicare will cover and what you will owe.

If you disagree with Medicare's decision about how many days it will cover, you have the right to appeal. The notice will explain how. You must appeal within 120 days of receiving the notice. Many people do not know they can appeal, so read the notice carefully.

What Happens After 100 Days

When Medicare's coverage ends on day 100, you must pay all nursing home costs yourself unless you have another source of payment. Your options are: pay out of pocket if you have savings, use long-term care insurance if you have a policy, or explore for Medicaid if you meet the income and asset limits.

If you think you might need Medicaid, explore before day 100 if possible. Medicaid can take weeks or months to process, and the nursing home may not hold your bed while you wait. Some facilities will let you stay as a private-pay resident while your Medicaid process is pending, but this is not may provide. Ask the nursing home administrator about their policy.

Some states allow Medicaid to cover nursing home costs retroactively — meaning it can pay for days before your process was approved, as long as you were already in the facility. Other states do not. Check your state's rules through your state Medicaid office or a local Area Agency on Aging.

Frequently Asked Questions

Does Medicare cover the cost of living in a nursing home if I do not need skilled care?

No. Medicare only covers skilled nursing care — medical treatment that requires a nurse or therapist. If you need a nursing home only for help with daily activities like bathing or eating, Medicare does not pay. Medicaid covers this type of care if you meet income and asset limits, but Medicare does not.

Can I choose any nursing home and have Medicare pay?

No. The nursing home must be Medicare-certified, and your doctor must order the care as a result of a hospital stay. You cannot move to a nursing home on your own and ask Medicare to pay retroactively. The hospital discharge planner will help you find a Medicare-certified facility.

What if I need nursing home care but was not in the hospital for three nights?

Medicare will not pay. You must have been admitted to a hospital as an inpatient for at least three consecutive nights. An observation stay or emergency room visit does not count. If you need nursing home care without a may have access to hospital stay, you would need to pay out of pocket or use Medicaid if you meet the income and asset limits.

Can I stay in a nursing home longer than 100 days on Medicare?

No. Medicare covers up to 100 days per benefit period. After day 100, you pay all costs. If you need to stay longer, you can use savings, long-term care insurance, or Medicaid (if you meet the limits). Some people return home and then have another hospital stay, which starts a new 100-day Medicare benefit period, but this must be medically necessary — you cannot plan it just to extend coverage.

Do I have to pay the copay for days 21–100 even if I leave early?

No. You only pay the daily copay for the days you actually stay. If you leave on day 35, you pay the copay for days 21–35 only. Days 1–20 are always free under Medicare, regardless of when you leave.