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 daily living like bathing and dressing) for any length of time. It covers skilled nursing care — medical treatment that requires a nurse or therapist — and only after you have spent at least three days in a hospital. The coverage lasts up to 100 days per benefit period, with you paying nothing for days 1–20, and a daily copay for days 21–100. After day 100, you pay the full cost yourself.

The catch is that Medicare decides whether your care qualifies as skilled or custodial, and that decision happens at the nursing home, not before you arrive. Many people enter a nursing home expecting Medicare to pay and discover partway through that Medicare will not cover their stay because the care they need is custodial, not skilled. Understanding the difference now — before you need a bed — saves you from a sudden bill you cannot pay.

Key Takeaways

  • Medicare covers skilled nursing care (medical treatment by nurses or therapists) for up to 100 days per benefit period, but only if you spent at least three days in a hospital first.
  • You pay nothing for days 1–20, then a daily copay (currently $194.50 per day in 2024, though this changes yearly) for days 21–100.
  • Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting — even if you stay in a nursing home for years.
  • The nursing home, not Medicare, decides whether your care is skilled or custodial, and that decision can change as your condition improves.
  • If Medicare stops covering your stay, Medicaid may take over if you meet income and asset limits, but you must check your state's rules.

The three-day hospital stay requirement

Medicare will not pay for a nursing home stay unless you have been an inpatient in a hospital for at least three consecutive days when ready before admission. The three days must be in a hospital, not an emergency room or observation unit — even if you spent time in the hospital's observation area, that time does not count toward the three days.

This rule trips up many people. You might spend two days in the hospital and then be sent to a nursing home for recovery, only to learn that Medicare will not pay because you did not meet the three-day threshold. The hospital and nursing home are separate entities, and Medicare tracks the hospital stay separately from the nursing home stay. If you do not have the three-day hospital stay, you will be responsible for the full nursing home bill from day one.

What counts as skilled nursing care

Skilled nursing care means medical treatment that requires the judgment and skill of a licensed nurse or therapist. Examples include wound care after surgery, intravenous medication, physical therapy after a stroke, or management of a complex medical condition. The care must be ordered by a doctor and must be necessary because of your hospital stay or acute condition.

Custodial care, by contrast, is help with activities of daily living — bathing, dressing, eating, toileting, and moving around. Even if a nurse provides this help, Medicare does not pay for it. The distinction matters because many nursing home residents need custodial care but not skilled care. If your condition improves and you no longer need skilled services, Medicare stops paying, even if you remain in the nursing home.

Medicare reviews your care plan regularly. If a therapist or nurse determines that you no longer need skilled services, Medicare will notify you and the nursing home. You then have the right to appeal that decision, but if the appeal is denied, you become responsible for the bill.

How long Medicare pays and what you owe

Medicare covers up to 100 days of skilled nursing care per benefit period (a benefit period begins when you enter the hospital and ends 60 days after you leave the nursing home). The payment structure is tiered:

  • Days 1–20: Medicare pays 100 percent of the cost. You pay nothing.
  • Days 21–100: You pay a daily copay. In 2024, this copay is $194.50 per day, but the amount changes each year.
  • Day 101 onward: You pay the full daily cost of the nursing home. Medicare pays nothing.

The daily copay for days 21–100 is substantial. Over 80 days, it adds up to more than $15,000. Many people have supplemental insurance (Medigap) that covers this copay, but not all plans do. Check your Medigap policy or ask your insurance agent whether your plan covers skilled nursing copays.

When Medicare coverage ends and what happens next

Medicare stops paying when one of three things happens: you have used all 100 days, your doctor determines you no longer need skilled care, or you are discharged from the nursing home. Once Medicare stops, you are responsible for the full cost unless another program takes over.

Medicaid may cover nursing home costs after Medicare ends, but only if you meet your state's income and asset limits. Medicaid is a joint federal-state program, and rules vary widely. Some states cover nursing home care generously; others have strict limits. You must contact your state Medicaid office or a local Area Agency on Aging to learn whether you may have access to. If you do may have access to, Medicaid typically covers custodial care indefinitely, which Medicare does not.

If you do not may have access to for Medicaid and Medicare has stopped paying, you will need to pay out of pocket or explore other options like long-term care insurance (if you have it) or financial information programs run by the nursing home itself. Some nursing homes offer reduced rates or payment plans for residents who cannot pay the full cost.

How to prepare before you need a nursing home

The time to understand these rules is before a hospital stay forces you into a nursing home. Review your Medicare coverage documents and ask your doctor or a social worker to explain what skilled nursing care means in your situation. If you have a chronic condition that might require nursing home care someday, ask whether you would likely need skilled services or only custodial care.

Check whether you have supplemental insurance (Medigap) and whether it covers skilled nursing copays. If you do not have supplemental insurance and are still within your Medigap enrollment window, consider whether a plan that covers nursing home costs makes sense for you. If you think you might eventually need long-term care, talk to a financial planner about whether long-term care insurance is worth the cost.

If you are already receiving Medicare and think you might enter a nursing home soon, contact your local Area Agency on Aging. They can explain your state's Medicaid rules and help you understand what to expect. The Eldercare Locator (1-800-677-1116) can connect you to your local agency.

Common mistakes to avoid

Do not assume that because you are in a nursing home, Medicare is paying. Ask the nursing home directly whether your stay is covered by Medicare and for how long. Request a written notice of Medicare coverage (called a Notice of Admission, Utilization Review, and Noncoverage) so you have documentation of what Medicare will and will not pay.

Do not ignore a notice that Medicare is stopping coverage. You have the right to appeal, and the appeal process can buy you time. If you receive a notice, contact the nursing home's social worker or patient advocate when ready. They can help you file an appeal or explore other payment options.

Do not wait until you are in a nursing home to learn about Medicaid. If you think you might need long-term care, research your state's Medicaid rules now. Some states require you to spend down your assets to a certain level before Medicaid will pay, and planning ahead can help you preserve more of your money for other needs.

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. Time in an emergency room or observation unit does not count. If you do not have the three-day stay, Medicare will not pay for the nursing home, and you will be responsible for the full cost from day one.

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

A skilled nursing facility (SNF) is a nursing home that is certified to provide skilled nursing care and accept Medicare payment. Not all nursing homes are certified SNFs. Before you are admitted, confirm that the facility is Medicare-certified and that your care will be classified as skilled, not custodial.

Can I appeal if Medicare says my care is not skilled?

Yes. You have the right to appeal within 120 days of receiving a notice that Medicare is stopping coverage. Contact the nursing home's patient advocate or social worker, or call 1-800-MEDICARE to request an appeal. The appeal process can take weeks, but during that time Medicare continues to pay.

Will Medicaid pay for nursing home care after Medicare stops?

Medicaid may pay, but only if you meet your state's income and asset limits. Rules vary by state. Contact your state Medicaid office or local Area Agency on Aging to learn whether you may have access to. If you do may have access to, Medicaid typically covers custodial care indefinitely, unlike Medicare.

What if I run out of Medicare coverage and cannot afford the nursing home?

Talk to the nursing home's social worker about payment options, financial information programs, or reduced rates. Some facilities offer sliding-scale fees or payment plans. You can also contact your local Area Agency on Aging for information about other programs that might help.