Medicare covers part of skilled nursing home care, but only under specific conditions
Medicare Part A pays for skilled nursing home stays, but only if you meet strict requirements. You must have been in a hospital for at least three consecutive days, enter the nursing home within 30 days of leaving the hospital, and need daily skilled care — not just help with daily tasks. Medicare pays the full cost for days 1 through 20, then you pay a daily coinsurance amount (which changes yearly) for days 21 through 100. After day 100 in a benefit period, Medicare stops paying and you pay all costs yourself.
The key word is skilled care. This means nursing services or physical, occupational, or speech therapy that only a trained medical professional can provide. If you need help bathing, dressing, or taking medication but not skilled nursing or therapy, Medicare will not cover it — that is custodial care, and Medicare does not pay for it anywhere.
Key Takeaways
- Medicare Part A covers skilled nursing home care only after a hospital stay of at least three consecutive days, and only if you enter the home within 30 days of discharge.
- Medicare pays 100 percent of costs for the first 20 days, then requires you to pay a daily coinsurance amount for days 21 through 100 in each benefit period.
- The care must be skilled — nursing services or therapy — not custodial help with bathing, dressing, or meals.
- After 100 days in a benefit period, Medicare coverage ends and you are responsible for all costs.
- A doctor must order the skilled nursing home care and document that it is medically necessary.
The three-day hospital stay requirement
You must spend at least three consecutive days in a hospital before Medicare will cover a skilled nursing home stay. The days must be consecutive — if you are admitted on Monday and discharged on Wednesday, that counts as three days. However, if you are admitted on Monday, discharged on Tuesday, and readmitted on Wednesday, the clock resets and you start counting again from the new admission.
Observation status in a hospital does not count as an inpatient stay for this purpose. Many people spend time in a hospital on observation — meaning they are being monitored but not formally admitted as an inpatient — and then assume they meet the three-day requirement. They do not. Only time spent as an inpatient (admitted to a bed with an inpatient status) counts toward the three days.
If you are unsure whether your hospital stay was inpatient or observation, ask the hospital billing department or your discharge planner before you leave. This detail determines whether Medicare will pay for your nursing home care.
What "skilled care" actually means
Medicare distinguishes between skilled care and custodial care. Skilled care includes wound care, intravenous therapy, catheter management, physical therapy, occupational therapy, and speech therapy — services that require a licensed nurse or therapist. Custodial care includes bathing, dressing, toileting, meal preparation, and medication reminders — tasks that a family member or aide can do.
A nursing home may provide both types of care, but Medicare pays only for the skilled portion. If you need help with daily living but your doctor does not order skilled nursing or therapy, Medicare will not cover your stay. You would pay out of pocket or use Medicaid if you meet that program's income and asset limits.
The type of care you need is documented in your discharge orders from the hospital. Your doctor must write that skilled nursing care or therapy is medically necessary. Without that order, the nursing home cannot bill Medicare, and you will be responsible for the bill.
How much you pay and when coverage ends
Medicare's payment structure for skilled nursing homes works in tiers. For days 1 through 20 of each benefit period, you pay nothing — Medicare covers 100 percent. Starting on day 21, you pay a daily coinsurance amount set by Medicare each year. This amount changes annually and is different from your hospital deductible.
Your coverage ends on day 100 of each benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home (or hospital, if you do not go to a nursing home). Once day 100 passes, Medicare pays nothing more, and you are responsible for all remaining costs. If you need care beyond 100 days, you must pay privately, use Medicaid, or rely on other resources.
Many people assume they can stay in a nursing home for as long as they need and Medicare will pay. That is not true. Plan ahead if you think you may need care beyond 100 days. Some people purchase long-term care insurance, and others rely on Medicaid once Medicare coverage ends.
The 30-day window after hospital discharge
You must enter the skilled nursing home within 30 days of leaving the hospital for Medicare to cover it. If you go home first and then enter a nursing home 40 days later, Medicare will not pay for that stay — you will be responsible for the full cost.
This rule exists to link the nursing home stay to the hospital treatment. Medicare assumes that if you need skilled care, it is because of the condition that put you in the hospital, and that care should begin soon after discharge. If you delay, Medicare considers it a separate event and does not cover it under the same benefit period.
If you are unsure whether you will need a nursing home, discuss it with your hospital discharge planner before you leave. They can help you arrange a placement within the 30-day window if it becomes necessary.
What happens if you stay longer than 100 days
Once Medicare coverage ends at day 100, you have several options. If you have a Medigap policy (supplemental insurance), check your plan documents — some Medigap plans cover part of the coinsurance costs during days 21 through 100, but none cover costs after day 100. If you have a Medicare Advantage plan, review your plan's coverage rules, as they may differ from Original Medicare.
Medicaid may cover long-term nursing home care if you meet income and asset limits, which vary by state. Some people spend down their savings to become Medicaid-may be able to access, though this is a complex decision that may benefit from legal or financial information. Others pay privately for as long as they can afford it, then transition to Medicaid.
Long-term care insurance, if you have it, may cover costs after Medicare ends. Review your policy to understand what it covers and when benefits begin. If you do not have insurance and cannot afford private pay, discuss options with the nursing home's social worker — they can explain what resources may be available in your state.
How to learn about Medicare will cover your stay
Before you enter a nursing home, ask the facility whether it is Medicare-certified. Only Medicare-certified nursing homes can bill Medicare for skilled care. The facility should give you a document called the "Notice of Medicare Non-Coverage" if Medicare will not cover your stay — this notice explains why and what you owe.
You can also contact Medicare directly at 1-800-MEDICARE to ask about your specific situation. Have your hospital discharge papers and doctor's orders ready. Medicare can tell you whether your hospital stay meets the three-day requirement and whether your ordered care qualifies as skilled care.
If you disagree with Medicare's decision not to cover your stay, you have the right to appeal. The nursing home or your doctor can help you file an appeal, and Medicare will review the decision. Appeals can take time, so ask about this process early if you think coverage should explore.
Frequently Asked Questions
Does Medicare cover a nursing home stay if I was in the hospital on observation status?
No. Observation status does not count as an inpatient hospital stay. You must be formally admitted as an inpatient for at least three consecutive days. If you were on observation, ask your hospital to review your status — sometimes it can be changed retroactively if the medical record supports it, but this is not may provide.
What if I need a nursing home but it has been more than 30 days since I left the hospital?
Medicare will not cover that stay under the hospital benefit. You would need to pay privately, use Medicaid if you meet the requirements, or explore other payment options. If you think the delay was not your fault, you can appeal to Medicare, but coverage is not may provide.
Can I use my Medigap insurance to cover costs after day 100?
No. Medigap plans do not cover skilled nursing home costs after day 100 of a benefit period. Some Medigap plans help pay the coinsurance during days 21 through 100, but coverage ends when Medicare coverage ends. Check your specific plan to see what it covers during days 21 through 100.
If I need skilled nursing care at home instead of in a nursing home, does Medicare cover it?
Yes, but under different rules. Medicare Part A covers home health care if a doctor orders it, you are homebound, and you need skilled nursing or therapy. Home health does not require a three-day hospital stay. However, coverage rules and limits differ from nursing home care, so discuss this option with your doctor and discharge planner.
What is the daily coinsurance amount I pay on days 21 through 100?
The amount changes each year and is set by Medicare. Contact Medicare at 1-800-MEDICARE or check Medicare.gov for the current year's amount. Your nursing home should also tell you this amount when you are admitted, as it is part of your financial responsibility.