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 expect. It does not cover long-term custodial care — the help with daily living that most people need in a nursing home. Instead, Medicare covers skilled nursing care, which is medical treatment you cannot get at home. That means physical therapy after a hip replacement, wound care after surgery, or intravenous antibiotics. The stay must follow a hospital admission of at least three days, and Medicare will only pay for up to 100 days in a benefit period.
If you need help with bathing, dressing, meals, or toileting — which is what most long-term nursing home residents need — Medicare does not pay. You or your family pay out of pocket, or Medicaid covers it if you meet income and asset limits. Understanding this difference is the first step to planning ahead, because the costs are very different and the payment sources are not the same.
Key Takeaways
- Medicare covers skilled nursing care (medical treatment) for up to 100 days after a hospital stay of at least three days, but does not cover custodial care like bathing or dressing.
- You pay nothing for days 1–20 of a Medicare-covered nursing home stay, and a daily copay (which varies by year) for days 21–100.
- Medicaid, not Medicare, covers long-term nursing home stays and custodial care, but only if your income and assets fall below your state's limits.
- Private long-term care insurance and out-of-pocket savings are the main ways people pay for nursing home costs that Medicare does not cover.
What Medicare actually pays for in a nursing home
Medicare Part A covers a nursing home stay only if three conditions are met. First, you must have been admitted to a hospital and stayed 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 for skilled care related to the condition you were hospitalized for.
Skilled care means medical or nursing treatment that requires a licensed nurse or therapist. Examples include physical therapy to regain strength after a stroke, occupational therapy to relearn daily tasks, wound care after surgery, or medication management for a complex condition. It does not include help with activities of daily living unless that help is part of a skilled service — for example, a therapist helping you practice bathing as part of your recovery plan is covered, but a nursing aide helping you bathe because you cannot do it yourself is not.
The nursing home must be Medicare-certified, meaning it meets federal standards and has a contract with Medicare. Most nursing homes are certified, but you should confirm this before admission. You can check on Medicare.gov or call the nursing home directly.
How much Medicare pays and what you pay
Medicare Part A covers the full cost of your nursing home stay for the first 20 days. Starting on day 21, you pay a daily copay amount that changes each year. In 2024, that copay is $194.50 per day, but this amount increases annually. You are responsible for this copay for days 21 through 100. After day 100 in a benefit period, Medicare pays nothing and you pay the full cost of the nursing home.
A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home without receiving skilled care. If you return to the hospital and then to a nursing home within that 60-day window, the days do not reset — you continue counting toward your 100-day limit. If you stay out of the hospital for 60 days, a new benefit period begins and you get another 100 days of coverage.
The copay covers room, board, and routine nursing care. It does not cover medications, medical equipment, or services not related to your skilled care — those may have separate costs. Ask the nursing home for an itemized list of what is and is not included in the daily rate.
When Medicare coverage ends and what happens next
Medicare stops paying when one of three things happens: you no longer need skilled care, you have used 100 days in your benefit period, or your doctor determines you are no longer making progress toward your recovery goals. A doctor or the nursing home care team will tell you when they believe you no longer need skilled care. You have the right to appeal this decision if you disagree.
When Medicare coverage ends, you have options. If you can go home safely, you may be discharged. If you need ongoing care but no longer may have access to for Medicare coverage, you can stay in the nursing home and pay privately, or you can explore whether Medicaid will cover your stay. Medicaid covers long-term nursing home care and custodial care, but only if your income and assets are below your state's limits. The process of moving from Medicare to Medicaid coverage can take time, so ask the nursing home's social worker about this transition before your Medicare days run out.
Medicaid coverage for long-term nursing home stays
Medicaid, not Medicare, is the program that pays for most long-term nursing home stays in the United States. Medicaid covers custodial care — help with bathing, dressing, eating, toileting, and other daily activities — which Medicare does not. It also covers the room and board costs of a nursing home stay that lasts months or years.
Medicaid is a joint federal and state program, so rules vary by state. To be covered by Medicaid for nursing home care, you must meet income and asset limits set by your state. Most states allow you to keep a small amount of assets (often $2,000 to $3,000) and a small monthly income, but anything above that disqualifies you. Your home, one vehicle, and some personal items are usually not counted as assets, but savings accounts, investments, and a second property are.
If you have too many assets to may have access to for Medicaid now, you may be able to spend down your assets on care or transfer them in ways that preserve Medicaid coverage. This is complex and has strict rules and timelines. A Medicaid planner or elder law attorney in your state can explain your options. Many nursing homes have social workers who can also point you toward local resources.
Private long-term care insurance and other payment options
Some people buy long-term care insurance before they need nursing home care. This insurance pays a daily or monthly benefit toward nursing home costs, home care, or assisted living. The benefit amount, how long it lasts, and what it covers depend on the policy you buy. Premiums are lower if you buy the policy when you are younger and healthier, but the policy is only useful if you actually use long-term care services.
If you do not have long-term care insurance and do not may have access to for Medicaid, you pay nursing home costs out of pocket. This is why many people plan ahead by setting aside savings, or by exploring whether family members can help with costs. Some nursing homes offer discounts for paying upfront or in full, though this is not common. Ask about payment plans or financial information programs when you are researching homes.
Veterans and their spouses may be covered under VA benefits for nursing home care. If you or your spouse served in the military, contact the Department of Veterans Affairs to learn whether you may have access to for aid and attendance benefits or other long-term care support.
How to plan ahead for nursing home costs
Start by understanding your own situation. If you have significant assets and income, you will likely pay privately for any long-term nursing home stay. If your income and assets are modest, Medicaid may cover you eventually, but you may need to spend down assets first. If you are a veteran, explore VA benefits. If you want to protect assets for your family, long-term care insurance is worth researching while you are still healthy enough to buy it.
Talk to your doctor and family about what kind of care you would want if you became seriously ill or injured. Would you want to go to a nursing home for rehabilitation, or would you prefer to recover at home with hired help? What matters to you in a living situation? These conversations help your family make decisions if you cannot, and they help you plan financially.
If you are already facing a nursing home stay, ask the hospital social worker or the nursing home's social worker for help understanding your coverage and options. They can explain what Medicare will pay, what you will owe, and what happens when coverage ends. They can also connect you with Medicaid planners or financial counselors if you need help.
Frequently Asked Questions
Does Medicare cover nursing home costs if I did not spend three days in the hospital first?
No. Medicare only covers a nursing home stay if you were admitted to a hospital and stayed at least three consecutive days before the nursing home admission. If you go directly from home or from an outpatient procedure to a nursing home, Medicare will not pay. You would need to pay privately or use Medicaid if you may have access to.
What is the difference between Medicare and Medicaid for nursing homes?
Medicare covers skilled nursing care for up to 100 days after a hospital stay. Medicaid covers long-term custodial care and nursing home stays for people with low income and assets. Most people who live in nursing homes long-term are covered by Medicaid, not Medicare. The two programs have different rules, different income and asset limits, and cover different types of care.
Can I stay in a nursing home after my 100 Medicare days run out?
Yes, but you will need to pay for it yourself or switch to Medicaid coverage if you may have access to. Talk to the nursing home's social worker before your 100 days end so you understand your options and can plan ahead. Some people move to a different facility, while others stay in the same home and pay privately or through Medicaid.
Does Medicare cover medications or medical equipment in a nursing home?
Medicare Part A covers routine medications and equipment as part of your daily copay during a covered stay. However, some medications and specialized equipment may have separate costs or may not be covered. Ask the nursing home to explain what is included in the daily rate and what costs extra before you are admitted.
What happens if I disagree with the nursing home's decision that I no longer need skilled care?
You have the right to appeal. Tell the nursing home or Medicare when ready if you believe you still need skilled care. You can request a detailed explanation of why they believe your care is no longer skilled, and you can ask for a second opinion from another doctor. Medicare has a formal appeal process; ask the nursing home or call Medicare at 1-800-MEDICARE for details.