Medicare Part A covers skilled nursing care, but only after a hospital stay and only for specific medical needs

Medicare Part A will pay for a stay in a skilled nursing facility (SNF) if you meet three conditions: you spent at least three consecutive days in a hospital, you were admitted to the SNF within 30 days of leaving the hospital, and a doctor says you need daily skilled nursing or rehabilitation services. Medicare does not pay for custodial care — help with bathing, dressing, or daily living — unless it is part of a skilled service like physical therapy.

The facility must be Medicare-certified, which most nursing homes are. Your doctor does not need to formally refer you; the hospital discharge planner typically handles the paperwork. If you go to a facility that is not Medicare-certified, Medicare will not pay, so confirm the facility's status before you arrive.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period, but you pay nothing for days 1–20 and a daily copay for days 21–100.
  • You must have been in a hospital for at least three consecutive days and admitted to the SNF within 30 days to be covered.
  • Medicare covers the cost of the room, meals, nursing care, and rehabilitation therapies, but not private-duty nurses or non-medical services like housekeeping.
  • If you stay longer than 100 days, you pay the full cost yourself unless you have a supplemental insurance plan or Medicaid covers the remainder.
  • Your hospital stay must be for an acute medical condition, not for observation or outpatient procedures, for the three-day requirement to count.

How many days Medicare will pay for

Medicare Part A covers up to 100 days in a skilled nursing facility during each benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the SNF with no readmission. If you return to the hospital and then to an SNF again, a new benefit period begins.

You pay nothing for days 1 through 20. For days 21 through 100, you pay a daily copay amount that changes each year — in 2024, that copay is $200 per day. After day 100, Medicare stops paying and you are responsible for the full cost. Many people do not stay the full 100 days; the average stay is two to three weeks.

What Medicare Part A actually covers in the facility

Medicare pays for a semi-private room (two beds), all meals, nursing care, medications, medical equipment like wheelchairs or walkers, and rehabilitation services such as physical therapy, occupational therapy, and speech therapy. It also covers lab work, X-rays, and other diagnostic tests ordered by your doctor while you are there.

Medicare does not pay for a private room unless it is medically necessary, in which case you may owe a difference in cost. It does not cover personal care items like toiletries, a telephone, or television, and it does not pay for services that are not medically necessary — such as a barber, beautician, or social activities — unless they are part of your treatment plan.

When the three-day hospital stay requirement does not count

The three days must be as an inpatient in the hospital, not as an outpatient or under observation. Many people are admitted to the hospital under "observation status" rather than as an inpatient, and observation days do not count toward the three-day requirement. This is a common source of confusion because you may feel like an inpatient, but the hospital's billing status determines whether the days count.

If you are unsure of your status, ask the hospital before discharge: "Am I admitted as an inpatient or under observation?" If you were under observation, you will not meet the three-day requirement and Medicare will not cover the SNF stay. You can file an appeal if you believe the observation status was incorrect, but this process takes time.

What happens when you run out of Medicare coverage

Once you have used 100 days in a benefit period, Medicare stops paying. At that point, you have three main options: pay out of pocket, use a supplemental insurance plan (Medigap) if you have one, or transition to Medicaid if you meet income and asset limits.

Some Medigap plans cover part or all of the copay for days 21–100, but they do not cover days after 100. Medicaid, the joint federal-state program for people with low income, does cover long-term nursing home care after Medicare ends, but you must meet your state's income and asset limits. Each state sets these limits differently, so contact your state Medicaid office to learn what applies to you.

How to confirm a facility accepts Medicare

Before you choose a nursing home, verify that it is Medicare-certified. You can search the Medicare Care Compare tool on Medicare.gov by entering the facility name and your state. The tool shows which facilities are certified, their inspection history, staffing levels, and quality ratings.

You can also call the facility directly and ask: "Are you Medicare-certified?" A facility that is not certified will not receive Medicare payment, and you would pay the full cost yourself. Some facilities are certified for Medicare but not for Medicaid, or vice versa, so if you think you may need Medicaid coverage later, ask about that too.

What to ask your doctor and hospital before discharge

Before you leave the hospital, ask your discharge planner or doctor these questions: "Am I being discharged as an inpatient or under observation?" "Do I need skilled nursing care, or just custodial care?" "How many days of skilled care do you expect I will need?" and "Which facilities near my home are Medicare-certified and have openings?"

If you are under observation status and worried about SNF coverage, ask whether the hospital can change your status to inpatient. Some hospitals will review this if you ask before discharge. If the status cannot be changed, understand that Medicare will not pay for the SNF stay, and plan accordingly.

Frequently Asked Questions

Does Medicare pay if I go directly to a nursing home without a hospital stay?

No. Medicare Part A covers skilled nursing care only after a hospital stay of at least three consecutive days as an inpatient. If you go directly from home to a nursing home, Medicare will not pay. You would need to pay out of pocket or use Medicaid if you meet the income limits.

What is the difference between skilled nursing care and custodial care?

Skilled nursing care is medical care that requires a nurse or therapist — wound care, medication management, physical therapy, or monitoring after surgery. Custodial care is help with daily activities like bathing or dressing. Medicare covers skilled care but not custodial care, even in a nursing home. If you only need custodial care, Medicare will not pay.

Can I choose any nursing home, or does it have to be near the hospital?

You can choose any Medicare-certified facility, but it must be within 30 days of your hospital discharge. The facility does not have to be near the hospital. However, if the facility is far from family or your doctor, you may want to consider travel and visiting when making your choice.

What if I improve before 100 days and no longer need skilled care?

If your doctor determines you no longer need skilled nursing care, Medicare stops paying even if you have days remaining. You can stay in the facility, but you would pay out of pocket for custodial care. Some facilities offer a transition to a lower level of care at a reduced cost.

Does my Medigap or supplemental insurance cover the copay for days 21–100?

Some Medigap plans do cover part or all of the daily copay for days 21–100, but coverage varies by plan. Check your policy documents or call your insurance company to see what your plan covers. Medigap does not cover days after 100.