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

Medicare will pay for skilled nursing facility care — not custodial care in a regular nursing home — for a limited time. The maximum is 100 days in each benefit period, which runs from the day you enter the hospital or nursing facility until 60 days have passed with no hospital or skilled nursing facility stay. After that 60-day gap, a new benefit period begins and your 100-day clock resets.

The catch is that Medicare only pays if you are there for skilled care: nursing services, physical therapy, occupational therapy, or speech therapy ordered by a doctor. If you need only help with daily activities like bathing or dressing — called custodial care — Medicare does not cover it, even on day one. Many people enter a nursing home thinking Medicare will pay and discover too late that they do not meet the skilled care requirement.

You must also have been in a hospital for at least three consecutive days (not counting the day you were discharged) within the 30 days before you enter the nursing facility. Without that hospital stay, Medicare will not cover the nursing home at all.

Key Takeaways

  • Medicare covers up to 100 days of skilled nursing facility care per benefit period, but only if you were hospitalized for at least three days first.
  • 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 several hundred dollars per day depending on your location.
  • Skilled care means nursing services or therapy ordered by a doctor — help with bathing or dressing alone does not count, and Medicare will not pay for it.
  • If you leave the facility and return within 60 days, you continue using the same 100-day benefit; if you stay out longer than 60 days, a new benefit period starts and you get another 100 days.

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, though you may still owe your hospital deductible if you have not met it yet in that benefit period.

From day 21 through day 100, Medicare continues to cover most of the cost, but you pay a daily coinsurance amount. This amount changes each year — in 2024 it was $200 per day, but it varies by year. Your nursing facility will tell you the exact amount when you arrive. After day 100, Medicare stops paying altogether and you become responsible for the entire bill.

This is why many people need a backup plan. Long-term care insurance, Medicaid, or personal savings often cover the costs after Medicare stops. Some people may have access to for Medicaid while still in the facility, which can take over payment if their assets fall below their state's limit.

The three-day hospital stay requirement

Medicare will not pay for any nursing home care unless you spent at least three consecutive days in a hospital when ready before entering the facility. The day you are discharged does not count toward those three days — so you need to be admitted on day one, stay through day two and day three, and be discharged on day four or later.

Observation status in a hospital does not count as an inpatient stay for this purpose. Many people spend two or three days in the hospital on observation and assume they meet the requirement, but Medicare treats observation differently. You can check your status by asking the hospital directly or by calling Medicare at 1-800-MEDICARE.

If you do not have the three-day hospital stay, you will need to pay for nursing home care out of pocket, through Medicaid, or through private insurance. There is no exception to this rule, even if your doctor says you need skilled care.

How the benefit period works and when it resets

Your benefit period is not a calendar year — it is tied to your hospital and nursing facility use. A benefit period begins the day you enter a hospital or skilled nursing facility as an inpatient. It ends 60 days after you leave both the hospital and the nursing facility without being readmitted.

If you leave the nursing facility on day 50 and return on day 70, you have broken the chain: the 60-day window has passed, so a new benefit period starts. You get a fresh 100 days of coverage. But if you leave on day 50 and return on day 55, you are still in the same benefit period and your 100-day count continues from where it left off — you do not start over at day one.

Once a new benefit period begins, you must meet the three-day hospital stay requirement again before Medicare will cover a nursing home stay. This means if you go home for 61 days and then need to return to a nursing facility, you will need another three-day hospital stay first, or Medicare will not pay.

Skilled care versus custodial care

The most common reason Medicare denies nursing home coverage is that the person needs custodial care, not skilled care. Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, and moving around. Nursing homes provide this, but Medicare does not pay for it.

Skilled care is different. It means you need services that can only be provided by a nurse or therapist, ordered by a doctor. Examples include wound care after surgery, intravenous medication, physical therapy to regain strength after a stroke, or occupational therapy to relearn how to dress yourself after an injury. The therapy or nursing service must be medically necessary and ordered as part of your recovery plan.

A nursing home can provide both skilled and custodial care. Medicare pays only for the skilled portion. If you need only custodial care, you pay the full cost yourself or through Medicaid, long-term care insurance, or other sources.

What happens when your 100 days end

On day 101, Medicare stops paying. Your nursing facility will send you a notice before this happens — usually around day 95 — telling you the exact date coverage ends. After that date, you are responsible for the full daily rate.

The daily cost of nursing home care varies widely by state and facility. In some areas it may be $200 to $300 per day; in others it can exceed $500 per day. Over a year, this adds up quickly. Many families face a difficult choice: move the person to a less expensive facility, explore Medicaid coverage, use long-term care insurance, or pay out of pocket.

Some people transition to Medicaid at this point. Medicaid covers long-term nursing home care with fewer time limits, but you must meet income and asset requirements that vary by state. Planning ahead — before you reach day 100 — gives you time to understand your options and make decisions with your family and social worker.

Planning ahead for costs after Medicare coverage ends

The 100-day limit means most people who need extended nursing home care will eventually pay out of pocket or through another source. Starting this conversation early — ideally before a health crisis — helps families prepare.

Long-term care insurance is one option, though it must be purchased before you need care and premiums increase with age. Medicaid is another, but rules about assets and income vary by state and the process process takes time. Some families set aside savings specifically for this purpose. Others explore whether the person has a life insurance policy with a long-term care rider.

Your nursing facility's social worker can help you understand what happens after day 100 and what options may be available based on your state, income, and assets. Having this conversation at the start of your stay — not on day 95 — gives you the most time to plan.

Frequently Asked Questions

Does Medicare pay for nursing home care if I did not have a three-day hospital stay?

No. Medicare will not cover any skilled nursing facility care without a prior three-day inpatient hospital stay. Observation status does not count. You would need to pay out of pocket, through Medicaid, or through private insurance.

If I go home after 50 days and come back after 30 days, do I start over at day one?

No. If you return within 60 days, you continue using the same benefit period and your day count picks up where it left off. You would have about 50 days of coverage remaining. If you stay out for more than 60 days, a new benefit period begins and you get another 100 days, but you must have another three-day hospital stay first.

What is the difference between skilled nursing facility and a regular nursing home?

A skilled nursing facility is licensed to provide skilled care — nursing services and therapy ordered by a doctor. A regular nursing home may provide only custodial care. Medicare only covers skilled nursing facilities, and only for skilled care. Ask your facility whether it is Medicare-certified and what level of care you are receiving.

Can I stay in a nursing home longer than 100 days if I pay myself?

Yes. After day 100, you can remain in the facility and pay the daily rate yourself, or through Medicaid if you meet the requirements. Many people do this. The 100-day limit applies only to Medicare coverage, not to your right to stay.

What should I do if Medicare denies coverage because they say I do not need skilled care?

You have the right to appeal. Ask your nursing facility or hospital for a detailed explanation of why coverage was denied. You can also contact Medicare at 1-800-MEDICARE or ask your state's Patient Advocate Foundation for help understanding your options.