Medicare covers skilled nursing care, but only under specific conditions

Medicare Part A pays for a stay in a skilled nursing facility (SNF) — a nursing home certified to provide medical care — but only if you meet strict requirements. You must have been hospitalized for at least three consecutive days, be admitted to the SNF within 30 days of leaving the hospital, and need daily skilled care (such as wound care, physical therapy, or medication management) that cannot be done at home. Medicare does not pay for custodial care — help with bathing, dressing, eating, or toileting — even in a nursing home.

The difference matters because many people enter nursing homes needing custodial care only, not skilled care. If that is your situation, Medicare will not cover it, and you will pay out of pocket or turn to Medicaid.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, but only if you need skilled medical care, not just help with daily activities.
  • You pay nothing for days 1–20, a daily copay (currently $200 per day in 2024, though this changes yearly) for days 21–100, and all costs after day 100.
  • If you need custodial care only — bathing, dressing, eating help — Medicare does not cover it, and you will need to pay privately or turn to Medicaid.
  • Medicaid, not Medicare, is the main payer for long-term nursing home stays and custodial care, but you must meet income and asset limits.
  • Your doctor and the nursing home must document that you need skilled care daily for Medicare to cover your stay.

How many days Medicare pays for and what you owe

Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility. A benefit period starts when you enter the hospital and ends 60 days after you leave the SNF with no hospital or SNF stay in between. You pay nothing for the first 20 days. From day 21 through day 100, you pay a daily copay — this amount changes each year and was $200 per day in 2024. After day 100, Medicare pays nothing, and you are responsible for the full cost.

The copay applies only to days you actually stay. If you are discharged on day 45, you owe copays for days 21–45 only. Many people do not stay the full 100 days; the average skilled nursing stay is two to three weeks.

What "skilled care" means in practice

Skilled care is medical or rehabilitative care that requires a nurse or therapist to deliver it safely and correctly. Examples include intravenous (IV) medications, wound dressing changes, catheter care, physical therapy after a hip fracture, speech therapy after a stroke, and monitoring for complications after surgery. A doctor's order and daily documentation by nursing staff are required for Medicare to cover the stay.

Custodial care — the most common type of help in nursing homes — is not skilled care. This includes bathing, dressing, grooming, toileting, eating information, and general supervision. Many people need custodial care but not skilled care. If your doctor determines you need only custodial care, Medicare will not pay, even if you are in a nursing home.

The nursing home's medical team will assess you within the first few days and determine whether your care is skilled or custodial. This assessment is crucial because it determines whether Medicare will cover your stay. If the assessment concludes you need custodial care only, you will receive a notice explaining that Medicare coverage is ending, and you will be told what you owe.

When Medicare coverage ends during your stay

Medicare can stop paying for your nursing home stay before day 100 if the medical team determines you no longer need skilled care. This happens when your condition improves enough that you can manage at home, or when your care needs shift to custodial only. The nursing home must notify you in writing at least two days before coverage ends, and you have the right to appeal the decision.

If you disagree with the decision to end coverage, you can request a Quality Improvement Organization (QIO) review within one day of receiving the notice. The QIO is an independent group that reviews whether the decision was correct. Requesting a review does not stop you from owing the bill if the review agrees with the nursing home, but it gives you a chance to challenge the decision before you owe anything beyond your copay.

Medicaid as the main payer for long-term nursing home care

Medicaid, not Medicare, is the primary payer for long-term nursing home stays and custodial care. Medicaid is a joint federal-state program for people with low income and limited assets. Each state sets its own income and asset limits, but generally you must have less than $2,000 in countable assets (rules vary by state) and income below a certain threshold to may have access to. Medicaid covers both skilled and custodial care in nursing homes.

Many people use Medicare first for the initial skilled nursing stay after a hospital discharge, then transition to Medicaid if they need to stay longer or if their care becomes custodial. To explore for Medicaid, contact your state's Medicaid office or your local social services department. The nursing home's social worker can often help you understand whether you may be may be able to access and what documents you will need.

Medicare Advantage and supplemental insurance coverage

If you have a Medicare Advantage plan (Part C), your coverage of skilled nursing care is the same as Original Medicare — up to 100 days per benefit period with the same copays. However, some Medicare Advantage plans offer additional benefits, such as covering some custodial care or extending coverage beyond 100 days. Check your plan's summary of benefits or call your plan to learn what it covers.

Medigap (supplemental insurance) policies can help pay the copays you owe during days 21–100, but they do not extend coverage beyond 100 days or cover custodial care. If you have a Medigap policy, check your policy documents or call your insurer to confirm what it covers.

What to ask your doctor and the nursing home

Before or shortly after admission, ask your doctor and the nursing home's care team these questions:

  • Does Medicare consider my care skilled or custodial?
  • How long do you expect I will need skilled care?
  • What will happen if my condition improves and I no longer need skilled care?
  • What is my daily copay, and how many days does Medicare expect to cover?
  • If Medicare coverage ends, what are my options for paying for continued care?
  • Should I start planning for Medicaid coverage in case I need to stay longer?

Ask for written documentation of the care plan and the skilled care services you are receiving. This record is important if you need to appeal a decision to end coverage.

When to contact Medicare or seek help

Contact Medicare (1-800-MEDICARE) if you receive a notice that your coverage is ending and you disagree with the decision, or if you have questions about your copay or what is covered. You can also ask the nursing home's social worker or patient advocate to help you understand the notice.

If you cannot afford the copay or do not have family to help pay, ask the nursing home's financial counselor about payment plans or whether you may be may be able to access for Medicaid while still in the facility. Some nursing homes have funds to help patients in financial hardship, though this varies.

Frequently Asked Questions

Does Medicare pay for a nursing home if I was not hospitalized first?

No. Medicare Part A covers skilled nursing care only if you were hospitalized for at least three consecutive days and admitted to the SNF within 30 days of discharge. If you go directly to a nursing home from home, Medicare will not pay. You would need to pay privately or turn to Medicaid if you meet the income and asset limits.

What happens if I run out of Medicare coverage before I am ready to leave?

After day 100, Medicare pays nothing. If you still need skilled care and cannot pay out of pocket, you may be able to transition to Medicaid if you meet the income and asset limits. The nursing home's social worker can help you understand your options and start the Medicaid process. Some people also move to a less intensive care setting, such as assisted living or home care.

Can I appeal if Medicare stops paying before day 100?

Yes. If you receive a notice that Medicare coverage is ending, you can request a Quality Improvement Organization (QIO) review within one day of the notice. The QIO will determine whether the decision to end coverage was correct. Request the review in writing or by phone — the notice will include instructions on how to request it.

Does Medicare pay for memory care or dementia care in a nursing home?

Medicare pays for skilled nursing care in a facility that specializes in dementia, but only if you meet the three-day hospital stay requirement and need skilled medical care — not custodial care or supervision only. If you need custodial care or memory care supervision without skilled medical care, Medicare does not cover it, and you would need to pay privately or turn to Medicaid.

What is the difference between a skilled nursing facility and a regular nursing home?

A skilled nursing facility (SNF) is certified by Medicare to provide skilled medical care under a doctor's supervision. A regular nursing home may provide custodial care only and may not be Medicare-certified. Medicare will only pay for care in a Medicare-certified SNF. Ask the facility whether it is Medicare-certified before admission.