Yes, nursing homes accept Medicare, but only for specific types of care and only for a limited time

Medicare covers skilled nursing care — medical treatment that requires a nurse or therapist — but not custodial care, which is help with daily tasks like bathing or dressing. A nursing home must be Medicare-certified to accept Medicare payment. Most large facilities are certified, but some smaller homes are not. The key difference: Medicare pays the facility directly for skilled care stays, usually for up to 100 days per benefit period, but only if you meet strict conditions first.

The most important condition is that you must have spent at least three consecutive days in a hospital before the nursing home stay begins. Medicare will not pay for a nursing home stay that starts from home or an outpatient visit, no matter how medically necessary the care is. This three-day hospital requirement is the single biggest reason people think Medicare should cover a stay but find out it does not.

Key Takeaways

  • Medicare only pays for skilled nursing care — medical treatment by nurses or therapists — not for help with bathing, dressing, or other daily tasks.
  • You must have spent at least three consecutive days in a hospital when ready before the nursing home stay for Medicare to pay anything.
  • Medicare-certified nursing homes are listed on Medicare.gov, and you can call ahead to confirm a facility accepts Medicare before admission.
  • Medicare covers up to 100 days per benefit period, but you pay a daily copay starting on day 21, and nothing after day 100.
  • If a nursing home is not Medicare-certified, Medicare will not pay even if you meet all other requirements — you would need to pay out of pocket or use Medicaid if you may have access to.

How to learn about a specific nursing home accepts Medicare

Start by checking the Medicare Care Compare tool on Medicare.gov. Type in the nursing home name or your zip code, and the tool shows you which facilities are Medicare-certified. A facility that appears in the results accepts Medicare. If a home does not appear, it is not certified, and Medicare will not pay for care there.

Call the nursing home directly and ask: "Are you Medicare-certified?" and "Do you currently have beds available for Medicare patients?" Some certified homes stop accepting Medicare admissions temporarily if they are full or understaffed. Asking both questions prevents you from going through the admission process only to learn they cannot take you. Ask also whether they specialize in your type of care — for example, some homes focus on cardiac recovery or wound care, while others handle general rehabilitation.

If you are being discharged from a hospital, the hospital discharge planner can tell you which nearby homes are certified and often can contact them on your behalf. This is usually faster than calling on your own, and the planner knows which homes have current bed availability.

What Medicare actually pays for in a nursing home

Medicare covers the cost of the room, meals, nursing care, therapy (physical, occupational, or speech), medications, and medical equipment while you are there for skilled care. It does not cover personal care attendants, private duty nurses, or non-medical services like haircuts or phone bills. If you need a service not on the covered list, you pay for it yourself.

The length of coverage depends on your progress. Medicare pays for the full cost of the first 20 days. From day 21 through day 100, you pay a daily copay (the amount changes each year; check Medicare.gov for the current figure). After day 100 in a single benefit period, Medicare pays nothing, and you must cover all costs yourself or switch to another payment source like Medicaid or private pay.

Your benefit period resets each October 1st. If you are discharged and readmitted after that date, you get a new 100-day window. If you are readmitted before October 1st, you are still in the same benefit period, and your remaining days count down from where you left off.

The three-day hospital stay requirement and why it matters

This rule is the reason many people are surprised Medicare will not pay. You must be admitted to a hospital as an inpatient (not just treated in the emergency room or observation) and stay for at least three consecutive calendar days. The day you are discharged counts as a day, but the day you are admitted does not. So a Monday admission, Tuesday, Wednesday, and Thursday discharge meets the requirement.

Observation status — when you are in the hospital but not formally admitted as an inpatient — does not count toward the three days, even if you are there for four or five days. This catches many people. Ask the hospital clearly: "Am I admitted as an inpatient, or am I in observation status?" If you are unsure, request an itemized bill; it will say "inpatient" or "observation" clearly.

If you do not meet the three-day requirement, Medicare will not pay for the nursing home stay at all. You would need to pay privately, use Medicaid if you may have access to, or look for a home that accepts private insurance or self-pay patients.

What happens if the nursing home is not Medicare-certified

If a facility is not certified, Medicare will not pay for your stay there, period. No exceptions. You would need to pay the full cost out of pocket, which typically ranges from $100 to $300 per day depending on the region and the level of care, though these figures vary widely. Some people in this situation turn to Medicaid, which has different rules and covers custodial care as well as skilled care, but Medicaid has its own income and asset limits.

Before you commit to a non-certified home, understand the full cost. Ask for a written estimate of daily charges, what is included, and what costs extra. Some families choose a non-certified home because it is closer to family or has a better reputation for a specific type of care, but they should do so knowingly and with a clear picture of the financial commitment.

How to appeal if Medicare denies payment for a nursing home stay

If Medicare stops paying before you think your skilled care has ended, you have the right to appeal. The nursing home must give you a written notice explaining why Medicare is ending coverage. Read it carefully — it will say something like "your condition has improved" or "the care you need is no longer skilled care."

You can disagree with this decision. Contact your Quality Improvement Organization (QIO), which is a contractor that reviews Medicare coverage decisions in your state. The nursing home or your doctor can help you find the QIO contact information, or you can search for it on Medicare.gov by state. You have a limited time to appeal — usually a few days — so act quickly if you want to challenge the decision.

An appeal does not automatically reverse the decision, but it does trigger a review by someone other than the nursing home. If the QIO agrees with Medicare, you can appeal further, but each step has a important date. Keep copies of all medical records and notes from your care team; these are your evidence that skilled care is still needed.

Medicaid and other payment options if Medicare does not cover your stay

If you do not meet Medicare's requirements — for example, you did not have a three-day hospital stay — Medicaid may cover a nursing home stay instead. Medicaid covers both skilled and custodial care, but it has strict income and asset limits that vary by state. Some people "spend down" their savings to reach Medicaid's threshold, though this is a complex process that usually requires help from an elder law attorney or financial planner.

Private long-term care insurance, if you have it, may cover nursing home costs. Check your policy to see what it covers and what the daily benefit is. Some people pay out of pocket for as long as they can, then switch to Medicaid once their savings are depleted. Others use a combination: Medicare for the first 100 days of skilled care, then Medicaid or private pay for ongoing custodial care.

Ask the nursing home's admissions office about payment options and whether they accept Medicaid, private insurance, or payment plans. Many homes work with families to find a solution that fits their situation.

Frequently Asked Questions

Can I use Medicare to pay for a nursing home if I did not spend three days in the hospital?

No. Medicare requires a three-day inpatient hospital stay when ready before the nursing home admission. Observation status, emergency room visits, or outpatient procedures do not count. If you do not meet this requirement, Medicare will not pay, and you would need to use Medicaid, private insurance, or pay out of pocket.

What is the difference between a Medicare-certified nursing home and one that is not?

A Medicare-certified home has met federal standards for staffing, safety, and medical care and can accept Medicare payment. A non-certified home may be perfectly good but straightforward has not gone through the certification process or does not meet Medicare's requirements. Medicare will not pay at a non-certified home under any circumstances.

If Medicare stops paying after 50 days, can I stay in the nursing home and pay privately?

Yes. You can stay and pay out of pocket, or you can transfer to another facility. The nursing home must give you written notice before Medicare stops paying and must tell you your options. Many people continue at the same home and pay privately, especially if they are close to going home or if moving would disrupt their care.

Does Medicare pay for custodial care in a nursing home?

No. Medicare only pays for skilled care — treatment that requires a nurse or therapist. Help with bathing, dressing, eating, or toileting is custodial care and is not covered by Medicare. If you need only custodial care, Medicaid may cover it if you may have access to, or you would pay privately.

How do I know if my nursing home stay is considered skilled care or custodial care?

Your doctor and the nursing home's care team make this information based on your medical condition and the type of treatment you need. If you are receiving physical therapy, wound care, medication management, or other medical treatment, it is likely skilled care. If you are mainly receiving help with daily activities, it is custodial care. If you disagree with the information, you can appeal through your state's Quality Improvement Organization.