Medicare covers some nursing home costs, but only under specific conditions and only for a limited time

Medicare will pay for a nursing home stay, but not the way most people think. It does not cover custodial care — help with bathing, dressing, meals, or daily living — which is what most nursing home residents need. Medicare only pays for skilled nursing care, which means medical treatment that requires a nurse or therapist: wound care after surgery, physical therapy, intravenous medication, or monitoring after a hospital stay. The stay must follow a hospital admission of at least three days, and Medicare will only pay for up to 100 days in a benefit period.

If you need a nursing home mainly for supervision and personal care, Medicare will not pay. That is where Medicaid, long-term care insurance, or your own savings come in. Understanding which type of care you actually need — and which program covers it — is the difference between a covered stay and a bill you pay yourself.

Key Takeaways

  • Medicare covers skilled nursing care (medical treatment by nurses or therapists) for up to 100 days after a hospital stay of at least three days, but does not cover custodial care or supervision.
  • You pay nothing for days 1–20, a daily copay for days 21–100, and all costs after day 100 unless you have another insurance source.
  • The nursing home must be Medicare-certified and you must be admitted as an inpatient to a hospital first — emergency room visits alone do not count.
  • If you need ongoing care after 100 days, Medicaid, long-term care insurance, or personal funds become your only options.
  • Many people confuse Medicare coverage with Medicaid coverage; they are separate programs with different rules.

The three-day hospital stay requirement

Medicare will only pay for a nursing home stay if you spent at least three consecutive days as an inpatient in a hospital when ready before. This means admitted to a hospital bed, not treated in an emergency room or observation unit. The three days must be consecutive calendar days — midnight to midnight — and the nursing home admission must happen within 30 days of your hospital discharge.

Many people arrive at a nursing home after an ER visit or an outpatient procedure and assume Medicare will cover it. It will not. You must have been admitted as an inpatient first. If you are unsure whether your hospital stay counted as inpatient or observation, ask the hospital billing department before you leave — the distinction determines whether Medicare will later pay for nursing home care.

What Medicare pays and what you pay

Medicare's payment structure changes based on how many days you stay. For days 1 through 20, Medicare covers the full cost of skilled nursing care and you pay nothing. For days 21 through 100, you pay a daily copay (the amount changes each year; check your Medicare Summary Notice or call 1-800-MEDICARE for the current figure). After day 100 in the same benefit period, Medicare stops paying entirely and you are responsible for all costs.

This copay applies only to the nursing home facility itself. If you receive therapy, imaging, lab work, or other services while in the nursing home, those may have separate costs depending on your coverage. Some people have supplemental insurance (Medigap) that covers the daily copay; others do not. Check your policy before admission so you know what to expect.

The 100-day limit resets each benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home without being readmitted. If you are readmitted to a hospital after that 60-day window, a new benefit period starts and your day count resets to 1.

The difference between skilled nursing and custodial care

This distinction is the reason most nursing home stays are not covered by Medicare. Skilled nursing care is treatment that requires the judgment and skill of a licensed nurse or therapist. Examples include wound dressing after surgery, catheter care, intravenous medication, physical therapy after a stroke, or monitoring vital signs for a condition that requires frequent assessment. The care must be ordered by a doctor and documented as medically necessary.

Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, grooming, and supervision. A nursing home resident may need custodial care because of dementia, frailty, or disability, but if that is the only care needed, Medicare does not pay. Many people move to a nursing home for exactly this reason — they can no longer live alone safely — and they discover too late that Medicare will not cover it. Medicaid covers custodial care in a nursing home, but only if you meet income and asset limits.

How to confirm the nursing home accepts Medicare

Not all nursing homes accept Medicare. Before you or a family member is admitted, confirm that the facility is Medicare-certified. You can search for certified facilities on Medicare.gov using the Nursing Home Compare tool, or call the nursing home directly and ask whether they accept Medicare for skilled nursing stays.

Being Medicare-certified means the home meets federal standards for staffing, safety, and care quality. It does not mean every resident's stay will be covered — that depends on whether the individual meets the three-day hospital stay requirement and the type of care they need. Ask the nursing home's admissions staff to verify your hospital records before you move in, so there are no surprises about what Medicare will pay.

What happens when Medicare coverage ends

If you reach day 100 and still need nursing home care, you have three main options: pay out of pocket, switch to Medicaid if you meet the income and asset limits, or rely on long-term care insurance if you have a policy.

Some people use their savings to cover the gap between day 100 and the point where they have spent down enough assets to become Medicaid-may be able to access. Others arrange to move to a less intensive setting, such as assisted living or home care, if their medical condition improves. A few have long-term care insurance that picks up where Medicare stops. Discuss these options with the nursing home's social worker or a financial counselor before day 100 arrives, so you have a plan in place.

Medicare versus Medicaid in a nursing home

Many people confuse these two programs because both can pay for nursing home care, but they work very differently. Medicare is federal health insurance based on age (65 and older) or disability, and it covers skilled nursing care for a limited time after a hospital stay. Medicaid is a joint federal-state program based on income and assets, and it covers both skilled nursing care and custodial care for as long as you remain may be able to access.

A nursing home resident might start with Medicare coverage for the first 100 days, then switch to Medicaid for ongoing care if they run out of money and meet Medicaid's limits. Some states allow people to keep a small amount of assets and still receive Medicaid; others have stricter rules. The rules vary by state, so contact your state Medicaid office or a long-term care counselor to understand what Medicaid will cover in your situation.

Frequently Asked Questions

Does Medicare cover nursing home care if I did not spend three days in a hospital?

No. Medicare requires a three-day inpatient hospital stay when ready before the nursing home admission. An emergency room visit, observation unit stay, or outpatient procedure does not count. If you are unsure whether your hospital stay was inpatient or observation, ask the hospital before you leave.

What if I need nursing home care but do not have a three-day hospital stay?

You would pay out of pocket, use Medicaid if you meet income and asset limits, or rely on long-term care insurance if you have a policy. Some people arrange home care or assisted living instead. A social worker at the nursing home can discuss payment options with you.

Can Medicare pay for a nursing home stay longer than 100 days?

No. Medicare covers up to 100 days per benefit period. After day 100, you must pay yourself, use Medicaid, or have another insurance source. A new benefit period begins only if you are readmitted to a hospital and then return to a nursing home within 30 days of discharge.

If I have a Medigap policy, does it cover the nursing home copay?

Some Medigap policies cover the daily copay for days 21–100, but not all. Check your policy documents or call your insurance company before admission. If your policy does cover it, the nursing home may bill the Medigap plan directly.

Does Medicare cover physical therapy in a nursing home?

Yes, if the therapy is ordered by a doctor and is part of your skilled nursing care plan. Physical therapy, occupational therapy, and speech therapy are covered under Medicare's skilled nursing benefit. However, the nursing home stay itself must still meet the three-day hospital stay requirement.