Medicare covers nursing home care only after a hospital stay, and only for skilled nursing, not custodial care
Medicare will pay for a nursing home stay, but only under specific conditions. You must have been admitted to a hospital for at least three consecutive days (not counting the discharge day), and you must move to a nursing home within 30 days of leaving the hospital. The nursing home must be Medicare-certified. Even then, Medicare only pays for skilled nursing care — medical services like wound care, physical therapy, or medication management — not for help with daily living like bathing, dressing, or eating.
If you need a nursing home but have not had a may have access to hospital stay, Medicare will not pay. If you are in a nursing home for custodial care only — meaning you need supervision and personal care but not medical treatment — Medicare does not cover it, even if you had a hospital stay. This is the most common reason Medicare coverage ends.
Key Takeaways
- Medicare covers up to 100 days in a nursing home per benefit period, but only after a three-day hospital stay and only for skilled nursing care.
- You pay nothing for days 1 through 20, but from day 21 onward you pay a daily coinsurance amount that changes each year.
- Coverage stops when your skilled nursing needs end, even if you are still in the nursing home, which often happens after two to three weeks.
- Medicaid, not Medicare, is the program that pays for long-term custodial nursing home care for people with limited income and assets.
- Private long-term care insurance and out-of-pocket payment are the other main ways people fund nursing home stays that Medicare does not cover.
The three-day hospital stay requirement and the 30-day window
To may have access to for Medicare nursing home coverage, you must spend three consecutive nights in a hospital as an inpatient. Observation stays do not count — you must be formally admitted as an inpatient. The clock starts on your first full day in the hospital and includes the third day, but not the day you are discharged.
After you leave the hospital, you have 30 days to enter a Medicare-certified nursing home. If you wait longer than 30 days, you lose the connection to that hospital stay and will not be covered. If you return to the hospital and have another three-day stay, a new benefit period begins and the 30-day clock resets.
How long Medicare pays and what you owe
Medicare covers up to 100 days of nursing home care per benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home (or after you stop receiving Medicare-covered care there). The amount you pay depends on which days you use.
Days 1 through 20 are fully covered by Medicare — you pay nothing except your regular Part B premium. From day 21 through day 100, you pay a daily coinsurance amount. In 2024, that amount is $200 per day, though it increases each year. After day 100, Medicare pays nothing and you are responsible for the full cost.
Most people's skilled nursing needs end well before day 100. Once your doctor determines you no longer need skilled care — even if you are still in the nursing home — Medicare stops paying. This often happens after 10 to 21 days. At that point, you either pay out of pocket, switch to Medicaid if you meet the income and asset limits, or leave the facility.
Skilled nursing care versus custodial care
The difference between skilled and custodial care determines whether Medicare pays. Skilled nursing care includes wound dressing changes, intravenous therapy, catheter care, physical therapy ordered by a doctor, occupational therapy, speech therapy, and monitoring of medical conditions that require a nurse's judgment. A registered nurse or licensed practical nurse must provide or supervise the care.
Custodial care is help with activities of daily living: bathing, dressing, grooming, toileting, eating, and moving around. It also includes supervision for people with dementia or mental illness. A nursing aide or family member can provide custodial care. Medicare does not pay for it, even in a nursing home, even after a hospital stay.
Many people enter a nursing home needing both. Medicare pays for the skilled portion while you or another payer covers the custodial portion. As your skilled needs decline, your Medicare coverage ends, but your custodial care needs may continue indefinitely.
When Medicare coverage ends
Medicare stops paying when your doctor determines you no longer need daily skilled nursing care. This decision is made by the nursing home's medical team, often in consultation with your doctor. You will receive a notice called a Notice of Non-Coverage that explains why coverage is ending and tells you how many days you have left before you must pay the full cost yourself.
You have the right to appeal this decision if you believe you still need skilled care. You can request a detailed explanation and ask for a review. The nursing home must give you at least two days' notice before coverage ends, unless you agree to an earlier date. If you appeal and Medicare agrees with you, coverage continues. If Medicare upholds the decision, you become responsible for all costs from that date forward.
Medicaid as the alternative for long-term nursing home care
If Medicare coverage ends but you still need nursing home care, Medicaid is often the next source of payment. Unlike Medicare, Medicaid does pay for custodial care in nursing homes for people who meet income and asset limits. Each state sets its own limits, but generally you must have less than $2,000 in countable assets (rules vary by state) and a monthly income below a certain threshold.
Medicaid coverage is not automatic. You must explore through your state's Medicaid office, and the process can take weeks or months. Some people "spend down" their assets to meet Medicaid limits, though there are rules about how quickly you can do this without penalty. If you think you may need Medicaid, talk to a social worker at the nursing home or contact your state Medicaid office early — do not wait until Medicare coverage ends.
Private long-term care insurance and self-pay options
Some people have private long-term care insurance that covers nursing home stays Medicare does not. These policies vary widely in what they cover, how much they pay per day, and how long benefits last. If you have a policy, contact the insurance company before entering a nursing home to understand what it will and will not pay.
Many people pay for nursing home care out of pocket using savings, retirement accounts, or help from family. Nursing home costs vary by location and level of care, ranging from roughly $100 to $300 per day or more. Some facilities offer financial information or sliding-scale fees based on income. Ask the nursing home's business office about payment options and whether they work with people who are transitioning from Medicare to Medicaid.
Frequently Asked Questions
Does Medicare pay for nursing home care without a hospital stay?
No. You must have a three-day inpatient hospital stay within 30 days before entering the nursing home. Observation stays do not count. If you need nursing home care but have not been hospitalized, Medicare will not pay, and you will need to use Medicaid, private insurance, or pay out of pocket.
What happens if I run out of Medicare coverage before I leave the nursing home?
You become responsible for the full daily cost. You can then explore Medicaid if you meet your state's income and asset limits, use private insurance if you have it, or pay out of pocket. The nursing home's social worker can help you understand your options and start a Medicaid process if needed.
Can I appeal if Medicare says I no longer need skilled care?
Yes. You have the right to request a detailed explanation and ask for a review. If you believe you still need skilled nursing care, you can file an appeal within the timeframe given in your Notice of Non-Coverage. The nursing home social worker or patient advocate can help you with the appeal process.
Does Medicare cover physical therapy in a nursing home?
Yes, if it is ordered by your doctor as part of your skilled nursing care plan and is medically necessary. Physical therapy, occupational therapy, and speech therapy are all covered as skilled services. Once your doctor determines therapy goals have been met or progress has stopped, Medicare coverage for that service may end.
Will Medicare pay if I choose a nursing home that is not Medicare-certified?
No. The nursing home must be Medicare-certified to receive Medicare payment. Before entering a facility, confirm with the nursing home that it is Medicare-certified. You can also search the Medicare Care Compare website to verify a facility's certification status.