Medicare covers nursing home care for up to 100 days per benefit period, but only if you meet specific conditions

Medicare pays for skilled nursing facility (SNF) care — not custodial care in a nursing home — and only after a hospital stay. You must have been admitted to a hospital for at least three consecutive days, then transferred to a Medicare-certified nursing facility within 30 days of leaving the hospital. The care you receive must be for a condition related to your hospital stay, and it must be skilled care — meaning a nurse or therapist must provide it, not just a nursing aide.

The 100-day limit resets each benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the skilled nursing facility. Once that period closes, a new one begins if you are hospitalized again.

Key Takeaways

  • Medicare covers up to 100 days of skilled nursing facility care per benefit period, but only after a may have access to hospital stay of at least three consecutive days.
  • You pay nothing for days 1 through 20, but from day 21 onward you pay a daily coinsurance amount that changes each year.
  • After day 100, Medicare stops paying and you or your family must cover the full cost, which averages $300 to $400 per day depending on your location.
  • The 100-day limit applies to each benefit period separately; a new benefit period begins if you are hospitalized again after 60 days outside a facility.
  • Custodial care — help with bathing, dressing, and meals — is never covered by Medicare, even within the 100-day window.

What Medicare pays and what you pay

For days 1 through 20 of your stay, Medicare covers the full cost of your skilled nursing facility care. You pay nothing during this time.

From day 21 through day 100, Medicare still pays most of the cost, but you pay a daily coinsurance amount. This amount changes each year. In 2024, the daily coinsurance is $200. In 2025, it is $205. You pay this amount for each day you stay in the facility from day 21 onward.

After day 100 in a single benefit period, Medicare stops paying entirely. You or your family becomes responsible for the full daily cost. Nursing home care costs vary widely by location and facility type, but typically ranges from $300 to $400 per day for a semi-private room, and more for a private room.

When the 100-day limit resets

Your benefit period is tied to your hospital stay, not to the calendar year. A new benefit period begins the day you enter the hospital. It ends 60 days after you are discharged from the skilled nursing facility.

If you leave the facility and return to the hospital within that 60-day window, you do not get a new 100-day count — you continue using the days you already used. But if you stay out of the hospital and out of a skilled nursing facility for the full 60 days after discharge, a new benefit period begins. If you are then hospitalized again, you start fresh with a new 100-day allowance.

This means you could theoretically receive 100 days of coverage multiple times in a single calendar year if you have multiple hospital stays separated by at least 60 days outside a facility.

The difference between skilled care and custodial care

Medicare only pays for skilled nursing care — care that requires a licensed nurse or therapist. Examples include wound care, physical therapy, occupational therapy, speech therapy, intravenous medication, catheter care, and monitoring of complex medical conditions.

Medicare does not pay for custodial care — help with activities of daily living like bathing, dressing, eating, toileting, and transferring in and out of bed. Even if you need custodial care and are in a nursing home, Medicare will not cover it. Medicaid may cover custodial care if you meet income and asset limits, but Medicare never does.

When you are admitted to a nursing facility, the facility must assess whether you need skilled care or custodial care. If the assessment determines you need only custodial care, Medicare will not pay, even if you were hospitalized first. This is one of the most common reasons people think Medicare should cover their nursing home stay but find out it does not.

What happens after Medicare stops paying

Once you have used your 100 days of Medicare coverage in a benefit period, you have several options for paying for continued nursing home care.

You can pay out of pocket if you have savings. Some people use long-term care insurance, which may cover nursing home costs if they purchased a policy before entering the facility. Medicaid covers nursing home care for people who meet income and asset limits, though the process of becoming Medicaid-may be able to access often requires spending down savings first. Some facilities offer payment plans or sliding scale fees based on income.

If you cannot pay and do not meet Medicaid income limits, talk to the facility's social worker or financial counselor. They can explain what options exist in your state and help you understand the next steps.

How to know if your stay will be covered

Before or shortly after you enter a nursing facility, ask the facility to confirm three things: (1) that it is Medicare-certified, (2) that your admission qualifies as skilled nursing care rather than custodial care, and (3) that your hospital stay met the three-day requirement. The facility's social worker or admissions staff can verify all three.

You will also receive a document called a Notice of Medicare Non-Coverage if the facility or Medicare determines that your care does not may have access to for coverage. This notice explains why coverage is being denied and tells you how to appeal. If you receive this notice, read it carefully and ask the facility social worker to explain it. You have the right to appeal the decision.

Keep copies of all documents related to your hospital stay and nursing facility admission. These include your hospital discharge papers, the nursing facility admission paperwork, and any notices about coverage or non-coverage. You will need these if you need to appeal or if you have questions later.

Planning ahead if you think you might need nursing home care

If you are facing a hospital stay or think you might need nursing home care in the future, understand now that Medicare's 100-day limit is not indefinite. Many people assume Medicare will cover a long-term nursing home stay and are shocked to learn it stops after 100 days.

Consider whether you have savings to cover costs beyond 100 days. If you do not, look into whether you might be may be able to access for Medicaid in your state. Medicaid rules vary, but generally you must have limited income and assets. Some people work with an elder law attorney to plan ahead, though this is not necessary for everyone.

If you have long-term care insurance, review your policy now to understand what it covers and what the waiting period is. If you do not have insurance and think you might need nursing home care, talk to an insurance agent about whether a policy makes sense for your situation.

Frequently Asked Questions

Does Medicare cover nursing home care without a hospital stay first?

No. Medicare only pays for skilled nursing facility care after a hospital admission of at least three consecutive days. If you go directly from home to a nursing facility, or if your hospital stay was only one or two days, Medicare will not pay for the nursing facility care.

If I use all 100 days, can I get more coverage later in the same year?

Only if you have a new hospital stay that begins a new benefit period. A new benefit period starts when you are admitted to the hospital. If you are hospitalized again after your previous benefit period ended (60 days after you left the nursing facility), you get a fresh 100-day allowance. But if you are still in the nursing facility or have not waited the full 60 days, you do not get additional days.

What if my doctor says I still need nursing home care after 100 days?

Medicare's coverage limit is 100 days per benefit period, regardless of medical need. Your doctor's opinion does not change this limit. After day 100, you must pay out of pocket, use long-term care insurance, or explore Medicaid coverage if you meet the income and asset requirements in your state.

Does Medicare cover a nursing home if I need help with bathing and dressing but not medical care?

No. Help with bathing, dressing, and other daily activities is custodial care, which Medicare never covers. Medicare only pays for skilled nursing care — care that requires a nurse or therapist. If you need only custodial care, you must pay out of pocket or use Medicaid if you may have access to.

Can I appeal if Medicare denies coverage for my nursing home stay?

Yes. If you receive a Notice of Medicare Non-Coverage, you have the right to appeal. The notice will explain how to file an appeal and what important date you have. You can also ask your nursing facility social worker or a patient advocate to help you understand the denial and file an appeal if you disagree with it.