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 room, board, or custodial care that makes up most of the bill. Medicare Part A covers skilled nursing care — the medical treatment you need after a hospital stay — for up to 100 days. After that, you pay the full cost yourself. Many people assume Medicare covers nursing homes the way it covers hospitals. It does not. The coverage is narrow, the time limit is firm, and most long-term nursing home residents end up paying out of pocket or turning to Medicaid.

The key to understanding Medicare's nursing home benefit is knowing the difference between skilled care and custodial care. Skilled care is medical treatment — wound dressing, intravenous medication, physical therapy — that requires a nurse or therapist. Custodial care is help with bathing, dressing, eating, and toileting. Medicare pays for skilled care only. If you need custodial care, you pay for it yourself or Medicaid covers it if you meet income and asset limits.

Key Takeaways

  • Medicare Part A covers skilled nursing care for up to 100 days only if you were hospitalized for at least three consecutive days first.
  • You pay nothing for days 1 to 20, a daily copay for days 21 to 100, and the full cost after day 100.
  • Medicare does not cover custodial care — help with bathing, dressing, meals, and daily living — which is what most nursing home residents actually need.
  • If you need long-term nursing home care, Medicaid (not Medicare) is the program that typically pays, but it requires you to spend down your savings first.
  • Medigap and Medicare Advantage plans may cover some of the copays Medicare leaves you responsible for, but they do not extend the 100-day limit.

What Medicare Part A Actually Covers in a Nursing Home

Medicare Part A covers skilled nursing care — medical services like wound care, intravenous therapy, physical therapy, or medication management — delivered by or under the supervision of a nurse. This is different from help with daily living. If you need someone to help you bathe, dress, eat, or use the toilet, that is custodial care, and Medicare does not pay for it.

The coverage only kicks in if you meet three conditions. First, you must have been admitted to a hospital as an inpatient for at least three consecutive days (not counting the day you leave). Second, you must be admitted to the nursing home within 30 days of leaving the hospital. Third, a doctor must order the nursing home stay as a continuation of your hospital treatment. If you go directly to a nursing home from home, or if you were in the hospital for observation only (not admitted as an inpatient), Medicare will not cover it.

Once those conditions are met, Medicare covers the full cost of skilled nursing care for days 1 through 20. From day 21 through day 100, you pay a daily copay. From day 101 onward, you pay the entire bill yourself. The nursing home must give you written notice if it believes your stay will not be covered by Medicare, and you have the right to appeal that decision.

How Much You Pay Out of Pocket

The daily copay for days 21 to 100 changes each year. In 2024, it is $194.50 per day. That means if you stay in a nursing home for the full 100 days, you will pay nothing for the first 20 days, then $194.50 per day for the next 80 days — a total of $15,560 in copays. After day 100, you pay whatever the nursing home charges, which varies widely by location and facility type but typically ranges from $8,000 to $15,000 per month.

These figures cover only what Medicare considers skilled nursing care. If the nursing home bills for services Medicare does not cover — such as a private room, phone, television, or personal care attendants — you pay for those separately. Many nursing homes charge extra for amenities or services beyond what Medicare defines as skilled care. Before you are admitted, ask the nursing home for a written list of what is included in the Medicare-covered rate and what costs extra.

When Medicare Coverage Ends and What Happens Next

Medicare coverage ends on day 100, regardless of whether you still need care. At that point, you have three options: pay the nursing home directly, move to a different facility that accepts Medicaid, or go home with home health care if Medicare approves it. The choice depends on your financial situation, your health needs, and whether the facility you are in accepts Medicaid.

Home health care is sometimes an option after a nursing home stay. Medicare Part A covers skilled home health services — such as nursing visits, physical therapy, or wound care — if a doctor orders them and you are homebound. Unlike the nursing home benefit, there is no day limit for home health care, though Medicare will stop paying once you no longer need skilled services. Ask your doctor or the nursing home discharge planner whether home health care is realistic for your situation.

If you need long-term nursing home care beyond 100 days, Medicaid is the program that typically pays. Medicaid is a joint federal and state program for people with low income and limited assets. Each state sets its own rules, but most require you to spend down your savings to a threshold (often $2,000 to $3,000) before Medicaid will cover nursing home costs. This is a separate process from Medicare and involves a different process through your state's Medicaid office.

Medicare Advantage and Medigap: Do They Help?

Medicare Advantage (Part C) plans are offered by private insurers and must cover everything Original Medicare covers, including the skilled nursing benefit. Some Advantage plans offer additional benefits, such as covering part or all of the daily copay for days 21 to 100. However, no Medicare Advantage plan extends the 100-day limit — that is set by federal law and applies to all Medicare beneficiaries regardless of which plan they choose.

Medigap (supplemental insurance) plans sold by private insurers can help pay the copays you owe under Original Medicare. Some Medigap plans cover the full daily copay for days 21 to 100; others cover part of it. Again, Medigap does not extend the 100-day limit. It only reduces what you pay during the days Medicare covers. If you have either an Advantage plan or a Medigap policy, check your plan documents or call the plan to ask what it covers for nursing home stays, because the answer varies by plan and by year.

The Difference Between Skilled Care and Custodial Care

This distinction is the reason Medicare covers some nursing home costs but not others. Skilled care requires the judgment and skill of a licensed nurse or therapist. Examples include managing a catheter, administering intravenous medications, wound care after surgery, or physical therapy to regain strength after a stroke. Custodial care is help with activities of daily living — bathing, dressing, grooming, eating, toileting, and moving around — that does not require a nurse's judgment.

Many people enter a nursing home needing skilled care (for example, after hip surgery) but stay because they also need custodial care. Once the skilled care phase ends, Medicare stops paying, even if you still live in the nursing home. At that point, you either pay privately or switch to Medicaid if you meet the income and asset limits. Some nursing homes are primarily skilled nursing facilities (SNFs), which focus on short-term recovery. Others are long-term care facilities that accept both skilled and custodial residents. Ask the facility upfront whether it accepts Medicare for the skilled phase and Medicaid for the long-term phase, because not all do.

How to Know if Your Nursing Home Stay Will Be Covered

Before you are discharged from the hospital, ask the hospital discharge planner whether your nursing home stay will be covered by Medicare. The planner should be able to tell you whether you meet the three conditions: a three-day hospital stay, admission to the nursing home within 30 days, and a doctor's order for skilled nursing care. Get this answer in writing if possible, because it affects your planning and your out-of-pocket costs.

When you arrive at the nursing home, ask for a document called the Notice of Medicare Non-Coverage if the facility believes Medicare will not cover your stay. This notice explains why and tells you how to appeal. If you receive this notice and disagree, you have the right to request a review by a Medicare contractor. Keep records of all hospital and nursing home bills, discharge summaries, and doctor's orders. If Medicare denies coverage later, you will need these documents to appeal.

Frequently Asked Questions

Does Medicare cover nursing home care if I did not have a hospital stay first?

No. Medicare Part A nursing home coverage requires a hospital stay of at least three consecutive days as an inpatient, followed by admission to the nursing home within 30 days. If you go directly to a nursing home from home, Medicare will not pay for it. You would need to pay privately or turn to Medicaid if you meet the income and asset limits.

What is the difference between Medicare and Medicaid for nursing homes?

Medicare is federal health insurance for people 65 and older; it covers skilled nursing care for up to 100 days after a hospital stay. Medicaid is a joint federal and state program for people with low income and limited assets; it covers long-term nursing home care, including custodial care, with no day limit. Most long-term nursing home residents eventually rely on Medicaid.

Can I use my Medicare Advantage plan instead of Original Medicare for nursing home coverage?

Yes. Medicare Advantage plans must cover the same skilled nursing benefit as Original Medicare — up to 100 days after a hospital stay. Some Advantage plans offer extra benefits, such as covering part of the daily copay. However, the 100-day limit applies to all Medicare beneficiaries regardless of which plan type they have.

What happens if I need nursing home care after day 100?

Medicare stops paying after day 100. You then pay the nursing home directly, move to a facility that accepts Medicaid, or go home with Medicare-covered home health care if a doctor orders it. If you need long-term care and have limited income and assets, you can explore Medicaid coverage, which requires a separate process and varies by state.

Will Medicare cover the cost of a private room in a nursing home?

Medicare covers the cost of a semi-private room (shared with one other patient) as part of skilled nursing care. If you choose a private room, you pay the difference between the semi-private rate and the private rate out of pocket. The same applies to other amenities like phone, television, or extra meals.