Medicare covers some nursing home costs, but only under specific conditions and only for a limited time
Medicare will pay for skilled nursing care in a nursing home, but not for custodial care — the day-to-day help with bathing, dressing, and meals that most people need long-term. The difference matters because it determines whether Medicare pays anything at all. You must have been hospitalized for at least three consecutive days, be admitted to the nursing home within 30 days of leaving the hospital, and need daily skilled nursing or rehabilitation services that only a nursing facility can provide. If you meet those conditions, Medicare covers the full cost of the first 20 days. From day 21 to day 100, you pay a daily coinsurance amount (which changes each year) and Medicare covers the rest. After day 100 in the same benefit period, Medicare pays nothing.
This coverage structure means Medicare functions as a short-term recovery tool, not a long-term care solution. Most people who need nursing home care for more than a few months will need to transition to Medicaid, private pay, or a combination of both. Understanding these limits before you enter a nursing home helps you and your family plan for what comes next.
Key Takeaways
- Medicare pays for skilled nursing care only after a hospital stay of at least three consecutive days, and only if you are admitted to the nursing home within 30 days.
- Medicare covers all costs for the first 20 days, then requires you to pay a daily coinsurance amount from days 21 to 100.
- Custodial care — help with bathing, dressing, toileting, and meals — is never covered by Medicare, even if you are in a nursing home.
- After 100 days in one benefit period, Medicare coverage ends completely, and you must pay out of pocket or use Medicaid if you may have access to.
- A three-day hospital stay must be for acute inpatient care, not observation; observation stays do not count toward the requirement.
The three-day hospital stay requirement and why it matters
The three-day stay must be for inpatient hospital care, not observation. This is a critical distinction that trips up many people. If your hospital paperwork says "observation" or "outpatient observation," those days do not count, even if you spent three nights in a hospital bed. You can ask the hospital to review your status if you believe you were misclassified, but the decision rests with the hospital and Medicare.
The hospital stay must also be for an acute medical condition — something that required intensive treatment. A stay for diagnostic testing alone, or for a condition that could be managed in an outpatient setting, may not may have access to. Once you are discharged, you have 30 days to enter the nursing home. If you wait longer than 30 days, you lose the connection to that hospital stay and must start over with a new hospitalization if you want Medicare to cover nursing home care later.
What "skilled nursing care" means and what it does not
Skilled nursing care means medical services that require a licensed nurse or therapist — wound care, intravenous medications, physical therapy, occupational therapy, or speech therapy. If you need these services daily and cannot safely receive them at home, Medicare will cover the nursing home stay. The nursing home must also be Medicare-certified, meaning it meets federal standards and has agreed to accept Medicare payment.
Custodial care — the help most nursing home residents actually need — is not skilled care. Bathing, dressing, toileting, eating, and moving around are custodial services. So is supervision for safety, medication reminders, or companionship. If you need only custodial care, Medicare will not pay for the nursing home, period. You will pay out of pocket or use Medicaid (if you meet income and asset limits) or long-term care insurance if you have it.
How much you pay after the first 20 days
From day 21 through day 100, you pay a daily coinsurance amount that Medicare sets each year. In 2024, that amount is $194.50 per day, but it changes annually. The nursing home bills Medicare for the remainder. After day 100 in the same benefit period, you pay the full daily rate yourself.
A benefit period runs from the first day you receive a covered hospital or nursing home service until you have been out of the hospital or nursing home for 60 consecutive days. Once that 60-day break ends, a new benefit period begins, and your day count resets to 1. This means you could potentially have Medicare coverage for another 100 days of nursing home care in a new benefit period, but only if you are hospitalized again first.
The difference between Medicare and Medicaid coverage
Medicare and Medicaid are separate programs with different rules. Medicare is based on your work history and age (or disability status); it does not ask about your income or assets. Medicaid is a needs-based program run by each state; it covers people with low income and limited assets. Medicaid will pay for custodial nursing home care that Medicare will not, but you must meet your state's income and asset limits.
Many people use both programs together: Medicare covers the skilled nursing portion for the first 100 days, and Medicaid covers the custodial care portion or takes over after Medicare ends. Some states have programs that help people plan ahead to preserve assets while still accessing Medicaid nursing home coverage. The rules vary by state, so contact your state Medicaid office or a local Area Agency on Aging to learn what is available where you live.
What happens when Medicare coverage ends
When you reach day 101 in the same benefit period, Medicare stops paying. You then owe the full daily rate of the nursing home — which can range from $100 to $300 or more per day depending on the facility and your location. You can continue living in the nursing home if you can pay privately, or you can move to a less expensive facility, return home with home care, or move to assisted living.
If you run out of money while in the nursing home, you may become may be able to access for Medicaid at that point. Medicaid will then cover the cost of the nursing home going forward, though you may be required to contribute your income (minus a small personal allowance) toward your care. Planning for this transition before you need nursing home care can help protect your savings and your spouse's financial security.
How to verify Medicare coverage before entering a nursing home
Before you are discharged from the hospital, ask the hospital discharge planner whether your stay qualifies for Medicare nursing home coverage. The hospital should provide you with a document called the "Important Message About Your Rights" (also called the "Detailed Notice of Discharge"), which explains your coverage and your appeal rights if you disagree with the decision.
When you arrive at the nursing home, ask the admissions staff to confirm that the facility is Medicare-certified and that your care plan includes skilled nursing services. Request a written summary of what Medicare will cover and for how long. If you have questions or disagree with the coverage decision, you have the right to appeal. The nursing home or your hospital should provide information about how to file an appeal with Medicare.
Frequently Asked Questions
Does Medicare cover nursing home care if I did not have a hospital stay first?
No. Medicare nursing home coverage requires a hospital stay of at least three consecutive days for acute inpatient care. If you enter a nursing home directly from home or from an outpatient setting, Medicare will not pay for it. You would need to pay privately or use Medicaid if you may have access to.
If I am in the hospital for observation, can that count toward the three-day requirement?
No. Observation stays do not count. Only inpatient hospital stays count. You can ask the hospital to review your status if you think you were wrongly classified as observation, but the decision is made by the hospital and Medicare, not by you or the nursing home.
What if I need nursing home care after 100 days — can I get Medicare to pay again?
Only if you have a new hospital stay of at least three consecutive days and are admitted to the nursing home within 30 days of discharge. A new hospital stay starts a new benefit period, which resets your 100-day count. Without a new hospitalization, Medicare will not cover additional nursing home days.
Will Medicare pay if I need help with bathing and dressing but not medical care?
No. Bathing, dressing, and other personal care are custodial services, not skilled nursing care. Medicare does not cover custodial care in a nursing home. Medicaid may cover it if you meet your state's income and asset limits.
Can I appeal if Medicare denies coverage for my nursing home stay?
Yes. You have the right to appeal. The hospital or nursing home should give you information about how to file an appeal with Medicare. You can also contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about your coverage or to file an appeal.