Medicare covers skilled nursing care for a limited time, not permanent residence
Medicare pays for nursing home care only when you need skilled nursing care — medical treatment that requires a nurse or therapist, not just help with daily tasks. This coverage is temporary. Medicare will pay for up to 100 days in a benefit period, but only if you meet specific conditions, and your out-of-pocket costs rise sharply after day 20.
The clock starts the day you are admitted to the nursing home, not the day you left the hospital. If you go home and return to the nursing home later, a new benefit period begins. Medicare does not pay for custodial care — help with bathing, dressing, meals, or toileting — even if you need it full-time. If that is all you need, Medicare stops paying, and you or your family must cover the cost.
Key Takeaways
- Medicare covers up to 100 days of skilled nursing care per benefit period, but only if you were hospitalized for at least three days first.
- You pay nothing for days 1 through 20; Medicare covers the full cost of the facility.
- On days 21 through 100, you pay a daily coinsurance amount (which changes yearly) and Medicare covers the rest.
- After day 100, Medicare stops paying entirely, and you must pay the full nursing home bill yourself or use Medicaid if you may have access to.
- If you need only help with daily living tasks and not medical care, Medicare does not pay from day one.
The three-day hospital stay requirement
Medicare nursing home coverage requires that you spend at least three consecutive days in a hospital first. The three days must be for inpatient care — not observation, not an emergency room visit, but admitted as an inpatient. Many people arrive at a nursing home after a hospital stay for surgery, a fall, a stroke, or an infection, and they meet this requirement automatically.
If you go directly to a nursing home without a hospital stay, or if you were only in the hospital for observation, Medicare will not pay for the nursing home care. Some facilities will bill you privately while you appeal or wait for coverage to begin. Ask the nursing home admissions office whether your hospital stay counts before you sign any paperwork.
Days 1 through 20: Medicare covers the full cost
For the first 20 days after admission, Medicare pays the entire cost of the nursing home, and you pay nothing. This applies only to skilled care — physical therapy, occupational therapy, wound care, medication management, or other treatment that requires a licensed nurse or therapist to deliver.
During these 20 days, the nursing home cannot charge you a copay, coinsurance, or any other amount for the care itself. You may still owe for items Medicare does not cover, such as a private room (if you choose one instead of a semi-private room), a telephone, or television. Ask the facility in writing what charges, if any, you will owe during this period.
Days 21 through 100: You pay coinsurance, Medicare covers the rest
Starting on day 21, you begin paying a daily coinsurance amount. For 2024, that amount is $194.50 per day. This figure changes each year on January 1. You pay this amount out of pocket for each day you stay, and Medicare covers the remaining cost of the facility.
The coinsurance applies only to days 21 through 100. If you stay all 100 days, you will owe 80 days × the daily coinsurance rate. Some people use long-term care insurance, savings, or family contributions to cover this cost. If you cannot afford it, ask the social worker at the nursing home whether you may be able to switch to Medicaid, which has different rules and may cover the cost if your income and assets are low enough.
After day 100: Medicare stops paying
Once you reach day 100 in a benefit period, Medicare coverage ends completely. You must pay the full daily rate of the nursing home yourself. The daily cost of skilled nursing care ranges widely depending on the facility and your location, but many facilities charge $300 to $500 per day or more.
If you cannot pay, your options are limited. You may be able to switch to Medicaid, which covers long-term nursing home care for people with low income and few assets, but Medicaid rules vary by state and have strict financial limits. You can also ask the nursing home about payment plans or financial information programs. Some facilities have charitable funds or sliding-scale fees, though these are not common.
What counts as a new benefit period
A benefit period is a calendar year for Medicare purposes. If you leave the nursing home and return later in the same year, you continue using the same 100-day benefit. If you leave the nursing home and stay out for 60 consecutive days, a new benefit period begins, and you get a fresh 100 days — but only if you meet the three-day hospital stay requirement again.
This matters because some people think they can leave a nursing home on day 99, wait a few weeks, and return to get another 100 days. That does not work unless you are hospitalized for three days in between. If you leave on day 99 and return on day 101 without a hospital stay, Medicare will not pay for the new stay.
Custodial care is not covered, even if you need it full-time
Medicare distinguishes between skilled care and custodial care. Skilled care requires a nurse or therapist — wound dressing, physical therapy, medication injections, catheter care. Custodial care is help with bathing, dressing, eating, toileting, and moving around. Many nursing home residents need custodial care but not skilled care.
If a doctor determines that you need only custodial care, Medicare will not pay, even if you were hospitalized first. The nursing home must tell you this in writing before you are admitted or as soon as the information is made. At that point, you must either pay privately or leave the facility. This is one of the most common reasons people lose Medicare coverage in a nursing home unexpectedly.
What to ask your doctor and the nursing home
Before admission, ask your doctor whether your condition requires skilled nursing care or only custodial care. Ask the nursing home admissions office to confirm in writing that Medicare will cover your stay and for how long. Request an estimate of your coinsurance costs for days 21 through 100.
Once you are admitted, ask the nursing home to notify you in writing if the care plan changes and skilled care is no longer needed. Medicare requires the facility to give you notice before coverage ends. If you disagree with the decision, you have the right to appeal. The nursing home must tell you how to file an appeal and what your rights are.
Frequently Asked Questions
Can I get more than 100 days of Medicare coverage in one year?
No. Medicare covers up to 100 days per benefit period, which is a calendar year. If you leave the nursing home and return within 60 days, you are still in the same benefit period and your days do not reset. You would need to be hospitalized for three days and then return to a nursing home in a new calendar year to get a fresh 100 days.
What happens if the nursing home says I no longer need skilled care?
The nursing home must notify you in writing before coverage ends. You have the right to appeal the decision if you believe you still need skilled care. Contact your state's Long-Term Care Ombudsman or call Medicare at 1-800-MEDICARE to learn how to file an appeal. Do not wait — appeals must be filed within a certain timeframe.
Does Medicare pay for a private room in the nursing home?
Medicare covers a semi-private room (two beds). If you choose a private room, you pay the difference between the semi-private and private rate out of pocket. The nursing home must tell you this cost before you are admitted.
What if I cannot afford the coinsurance on days 21 through 100?
Ask the nursing home social worker about Medicaid coverage in your state. Some states cover nursing home care for people who cannot afford it, though income and asset limits explore. You may also ask about payment plans or financial information programs the facility offers.
Does my supplemental insurance or Medigap plan cover the nursing home coinsurance?
Some Medigap plans cover part or all of the daily coinsurance on days 21 through 100. Check your policy or call your insurance company to find out. If you do not have Medigap, ask the nursing home whether they accept any other insurance that might help cover the cost.