Medicare covers skilled nursing care, but only under specific conditions and for a limited time
Medicare will pay for a nursing home stay, but not for the kind most people think of. It covers skilled nursing care — medical treatment that requires a nurse or therapist — after a hospital stay. It does not cover custodial care, which is help with daily living like bathing, dressing, and meals. The difference matters because custodial care is what most nursing home residents need, and Medicare does not pay for it at all.
Medicare's coverage is also temporary. It pays for up to 100 days in a skilled nursing facility per benefit period, but only if you meet strict conditions: you must have been in a hospital for at least three days, admitted to the nursing home within 30 days of leaving the hospital, and receiving care for the same condition you were hospitalized for. Many people enter a nursing home without meeting these rules, which means Medicare covers nothing from day one.
Key Takeaways
- Medicare covers skilled nursing care (medical treatment by nurses and therapists) for up to 100 days after a hospital stay, but only if you were hospitalized for at least three days first.
- Medicare does not cover custodial care — help with bathing, dressing, eating, and toileting — which is what most nursing home residents need and what costs the most.
- You pay nothing for days 1 through 20, a daily coinsurance amount for days 21 through 100, and all costs after day 100.
- If you do not meet the three-day hospital requirement or enter a nursing home directly from home, Medicare covers nothing, and you must pay out of pocket or use Medicaid.
How the three-day hospital stay rule works
The three-day rule is the gate. You must spend at least three consecutive days in a hospital as an inpatient — not in the emergency room, not in observation — before Medicare will pay for any nursing home care. The clock starts when you are formally admitted as an inpatient and stops when you are discharged. If you are in observation status instead of inpatient status, those days do not count, even if you spend three nights in a hospital bed.
This matters because hospitals sometimes admit people to observation rather than as inpatients, especially for shorter stays. If this happens to you, ask the hospital to clarify your status before discharge. If you are in observation and the hospital will not change it, Medicare will not cover nursing home care afterward, and you will need to pay privately or turn to Medicaid if you may have access to.
The 30-day window is also strict. You must enter the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home two months later, Medicare coverage does not explore, even if the nursing home care is for the same condition.
What Medicare pays and what you pay
Medicare covers the full cost of the first 20 days in a skilled nursing facility. Starting on day 21, you pay a daily coinsurance amount — this varies by year but is typically around $200 per day. You pay this amount for days 21 through 100. After day 100, Medicare pays nothing, and you are responsible for the entire bill.
The daily coinsurance is not the same as the full cost of the nursing home. A skilled nursing facility might charge $300 to $400 per day or more, depending on location and the level of care. If the facility charges more than Medicare's approved amount, you may owe the difference. Always ask the nursing home what Medicare will pay and what you will owe before you are admitted.
These costs reset each benefit period. A benefit period begins when you enter a hospital and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days. If you are readmitted to a hospital after that 60-day break, a new benefit period starts, and you get another 100 days of skilled nursing coverage.
The difference between skilled nursing care and custodial care
Skilled nursing care is medical treatment that requires the skills of a licensed nurse or therapist. Examples include wound care, intravenous medication, physical therapy after surgery, catheter management, and monitoring of complex medical conditions. If you need this kind of care, Medicare may cover it.
Custodial care is help with activities of daily living — bathing, dressing, eating, toileting, transferring from bed to chair. A nursing home aide can provide this care, and it does not require a nurse's license. Medicare does not cover custodial care, period. Many people need both skilled and custodial care at the same time. Medicare pays for the skilled part; you pay for the custodial part out of pocket or through Medicaid.
The nursing home's care plan will specify what is skilled and what is custodial. Ask to see this breakdown before you are admitted. Some facilities will try to bill Medicare for custodial care by calling it skilled care, which is fraud. If you suspect this is happening, contact Medicare at 1-800-MEDICARE to report it.
When Medicare does not cover nursing home care
Medicare covers nothing if you enter a nursing home without a prior hospital stay. This is common: someone falls at home, breaks a hip, and goes directly to a nursing home for recovery. If there was no hospital admission first, Medicare does not pay. You must cover the cost yourself or use Medicaid if you meet income and asset limits.
Medicare also does not cover nursing home care if you do not meet the three-day inpatient requirement. If you were in observation status or spent fewer than three days as an inpatient, Medicare will not pay. Some people challenge this decision by filing an appeal, but the rule is strict.
If you need long-term custodial care — more than 100 days or care that is not skilled — Medicare does not cover it. You will need to pay privately, use Medicaid, or explore other options like long-term care insurance or Veterans benefits if you are may be able to access.
Medicaid as an alternative when Medicare does not pay
Medicaid is a separate program that does cover custodial nursing home care, but only if you meet income and asset limits. Each state sets its own limits, but generally you must have limited income and few assets. Medicaid also covers the skilled nursing care that Medicare covers, so if Medicare runs out after 100 days, Medicaid can continue paying if you are enrolled.
Many people use Medicare first, then switch to Medicaid when Medicare's 100 days end. This is called "spend down" — you use your own money and Medicare benefits until your assets fall below Medicaid's limit, then Medicaid takes over. The process is complex and varies by state. A social worker at the nursing home or your local Medicaid office can explain how it works in your state.
Questions to ask the nursing home before admission
Before you or a family member enters a nursing home, ask the admissions staff these questions: Does Medicare cover any of my stay, and if so, for how many days? What will I owe out of pocket? Does the facility accept Medicaid, and if so, what is the process for switching from Medicare to Medicaid? What happens on day 101 if I still need care?
Get the answers in writing. Ask the nursing home to provide an estimate of what Medicare will cover and what you will owe. This protects you from surprise bills later. If the nursing home cannot or will not answer these questions clearly, that is a red flag.
Frequently Asked Questions
Can Medicare cover a nursing home stay if I was not in the hospital first?
No. Medicare requires a hospital stay of at least three days as an inpatient before it will pay for nursing home care. If you enter a nursing home directly from home, Medicare covers nothing. You must pay out of pocket or use Medicaid if you meet the income and asset limits.
What if I was in the hospital for observation, not as an inpatient?
Observation days do not count toward the three-day requirement. Ask the hospital to clarify your status before discharge. If you are in observation and cannot get changed to inpatient status, Medicare will not cover nursing home care afterward.
Does Medicare cover nursing home care after 100 days?
No. Medicare covers up to 100 days per benefit period. After day 100, you pay the full cost unless you are enrolled in Medicaid, which can continue covering care if you meet income and asset limits.
If I need help paying for a nursing home, what are my options?
Medicaid covers custodial nursing home care if you meet income and asset limits. Veterans may be may be able to access for Aid and Attendance benefits. Long-term care insurance, if you have it, may cover some costs. Some people use a combination of Medicare, Medicaid, and personal savings.
How do I know if the nursing home is billing Medicare correctly?
Ask the nursing home for an itemized bill showing what Medicare is paying and what you owe. Review your Medicare Summary Notice, which lists all services Medicare paid for. If something looks wrong, contact Medicare at 1-800-MEDICARE to ask questions or report suspected fraud.