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

Medicare pays for skilled nursing facility (SNF) care — not custodial care or long-term residence. The difference matters: skilled care means you need daily medical treatment or rehabilitation that only a nurse or therapist can provide. If you need help with bathing, dressing, or meals but not medical care, Medicare does not pay. Most nursing home residents need custodial care, which Medicare does not cover at all.

Medicare will pay for up to 100 days in a skilled nursing facility per benefit period, but only if you meet the entry requirements. You must have been in a hospital for at least three consecutive days (not counting the day you leave), and you must enter the nursing home within 30 days of leaving the hospital. You also must be admitted to the facility for the same condition you were treated for in the hospital, or a related one.

Even when Medicare does pay, you pay part of the cost yourself. For days 1 through 20, Medicare covers everything. For days 21 through 100, you pay a daily coinsurance amount (the exact dollar amount changes each year) and Medicare covers the rest. After day 100, you pay the full cost.

Key Takeaways

  • Medicare only pays for skilled nursing care — medical treatment or rehabilitation — not help with daily living tasks like bathing or eating.
  • You must have spent at least three consecutive days in a hospital before entering the nursing home, and you must enter within 30 days of discharge.
  • Medicare covers up to 100 days per benefit period, with you paying nothing for days 1–20 and a daily coinsurance amount for days 21–100.
  • After 100 days, you pay the full nursing home cost unless you have Medicaid, a Medigap plan, or long-term care insurance.

The three-day hospital stay requirement and why it matters

The three-day rule is strict: you must be admitted to the hospital (not just the emergency room) and stay for three full calendar days. The day you are admitted does not count; the day you leave does not count. So if you enter on Monday and leave on Thursday, that counts as three days (Tuesday, Wednesday, Thursday). If you leave on Wednesday, it does not count.

This requirement blocks many people from Medicare-paid nursing home care. If you have outpatient surgery, spend one night in the hospital, or are treated in an observation bed (which is different from an inpatient admission), the three-day clock does not start. You can ask the hospital to clarify your admission status before you leave — it will be listed on your discharge papers as "inpatient" or "observation." If you were on observation status and believe it was wrong, you can file an appeal, but this takes time and the nursing home will not wait.

What "skilled care" actually means in practice

Skilled nursing care is medical or rehabilitative treatment that requires a licensed nurse, physical therapist, occupational therapist, or speech therapist. Examples include wound care after surgery, intravenous medication, catheter management, physical therapy after a stroke or hip replacement, or speech therapy after a swallowing problem. If you need these services daily or several times a week, Medicare may pay.

Custodial care — help with bathing, dressing, toileting, eating, and moving around — is not skilled care, even if a nurse provides it. Neither is supervision, medication reminders, or monitoring of a chronic condition without active treatment. Many nursing home residents need only custodial care, which is why Medicare does not pay for them. This is where Medicaid, long-term care insurance, or personal funds take over.

The line between skilled and custodial can blur. A resident recovering from a hip replacement may need physical therapy (skilled) and help getting dressed (custodial). Medicare pays for the skilled part; you or another payer covers the custodial part. The nursing home must separate these costs on your bill.

How the 100-day limit works and what happens after

The 100-day limit resets each time you start a new benefit period. A benefit period begins when you enter a hospital and ends 60 days after you leave a skilled nursing facility (or hospital, if you do not go to a nursing home). If you are readmitted to the hospital more than 60 days after leaving the nursing home, a new benefit period starts and your day count resets to zero.

Days 1 through 20 are fully covered by Medicare — you pay nothing except your regular Medicare Part A deductible (which you pay once per benefit period, usually when you enter the hospital). On days 21 through 100, you pay a coinsurance amount per day; in 2024, this was $194 per day, but it changes annually. Medicare covers the rest of the facility's charge. After day 100, Medicare pays nothing and you are responsible for the full cost.

If you run out of Medicare coverage before you are ready to leave, you need another source of payment. Medicaid covers long-term nursing home care for people who meet income and asset limits, but you must first spend down your savings to the Medicaid threshold. Long-term care insurance, if you have it, may cover some or all of the cost. Otherwise, you or your family pay out of pocket.

Medigap and Medicare Advantage plans: what they cover

Medigap (supplemental insurance) plans vary in what they cover for nursing homes. Some plans cover the coinsurance amount for days 21–100, which means you pay nothing during that period. Other plans cover less or nothing. Check your specific plan documents or call your insurer to learn what your plan covers.

Medicare Advantage plans (Part C) must cover at least as much as Original Medicare, but they often have different rules. Some Advantage plans cover the coinsurance; others do not. Some require you to use in-network facilities. Call your plan before you enter a nursing home to understand what you will owe.

Neither Medigap nor Medicare Advantage covers care after day 100. Once Medicare stops paying, supplemental insurance usually stops as well. This is another reason why long-term care insurance or Medicaid becomes important for stays longer than 100 days.

Medicaid coverage when Medicare runs out

Medicaid is a joint federal and state program that covers long-term nursing home care for people with low income and limited assets. Unlike Medicare, Medicaid has no day limit — it can pay for years of care. However, Medicaid has strict financial limits. In most states, you must have less than $2,000 in countable assets (the exact limit varies by state) and monthly income below a certain threshold to be Medicaid-may be able to access.

If you have more assets than the Medicaid limit, you must spend them down on nursing home care before Medicaid will pay. This process is called "spending down to Medicaid." Some assets are protected — your home (up to a certain value in some states), one car, personal items, and a small amount of cash. Other assets, like savings and investments, are counted.

Medicaid planning is complex and state-specific. If you think you may need long-term nursing home care and have significant assets, speaking with an elder law attorney before you enter a facility can help you understand your options and protect assets legally. Many states have Medicaid planning rules that allow you to transfer certain assets without penalty if done correctly and far enough in advance.

How to find out what you will owe before you enter

Before you or a family member enters a nursing home, ask the facility for a written estimate of charges and ask your Medicare plan what it will cover. Request this in writing so you have a record. The nursing home must provide you with a written notice of charges and what Medicare, Medicaid, or insurance will cover before or at admission.

Call your Medicare plan (the number is on your insurance card) and ask: "I am entering [facility name] for skilled nursing care. What will Medicare pay, and what will I owe?" If you have Medigap or Medicare Advantage, ask the same question of that plan. Write down the name of the person you spoke to, the date, and what they told you.

If you are on Original Medicare with no supplemental plan, you will owe the coinsurance amount for days 21–100 (currently $194 per day in 2024, but this changes yearly). Multiply that by the number of days you expect to stay to get a rough estimate. If you expect to stay longer than 100 days, ask the nursing home and your state Medicaid office about Medicaid coverage and what you must do to may have access to.

Frequently Asked Questions

Does Medicare pay for nursing home care if I did not spend three days in the hospital?

No. The three-day inpatient hospital stay is a requirement Medicare enforces strictly. If you were in observation status or had outpatient surgery, those days do not count. You can appeal if you believe your admission status was wrong, but this takes time and the nursing home will not wait for the appeal to finish.

What if I need nursing home care but do not have a recent hospital stay?

Medicare will not pay. You would need to pay out of pocket, use long-term care insurance if you have it, or explore Medicaid if you meet the income and asset limits. Some people enter a nursing home as a private-pay resident and later may have access to for Medicaid after spending down their assets.

Can I use Medicare to pay for a nursing home indefinitely?

No. Medicare covers up to 100 days per benefit period. After that, you must find another source of payment: Medicaid (if you may have access to), long-term care insurance, family support, or personal funds. This is why many people purchase long-term care insurance while they are younger and healthier.

If I have a Medigap plan, will it pay for nursing home care after Medicare stops?

Most Medigap plans cover the coinsurance for days 21–100, but they do not cover care after day 100. Once Medicare's 100-day limit is reached, Medigap coverage ends. You would need Medicaid or another source of payment for longer stays.

How do I know if a nursing home is Medicare-certified?

Medicare only pays facilities that are certified to provide skilled nursing care. You can search for certified facilities on Medicare.gov or ask the facility directly whether it is Medicare-certified. If it is not certified, Medicare will not pay for your stay there, even if you meet all other requirements.