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

Medicare will pay for a nursing home stay, but only if you meet strict requirements: you must have been admitted to a hospital first, stayed at least three consecutive days, and enter a skilled nursing facility (SNF) within 30 days of hospital discharge. Medicare does not cover custodial care — help with daily living like bathing or dressing — which is what most long-term nursing home residents need. If you need ongoing help but do not require skilled medical care, Medicare will not pay, and you will need to cover costs yourself or turn to Medicaid.

The difference between skilled care and custodial care matters because it determines who pays. Skilled nursing care means a nurse or therapist must provide the care — wound dressing, physical therapy, medication management, or monitoring after surgery. Custodial care is what nursing aides do: bathing, toileting, dressing, eating. Many people move to a nursing home expecting Medicare to cover it, then discover they are paying out of pocket because they only need custodial care.

Key Takeaways

  • Medicare covers skilled nursing facility care only after a hospital stay of at least three consecutive days, and only for up to 100 days per benefit period.
  • You pay nothing for days 1–20, a daily copay (currently $194.50 per day, though this amount changes yearly) for days 21–100, and all costs after day 100.
  • Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting — which is what most long-term nursing home residents receive.
  • If you need long-term custodial care, Medicaid (not Medicare) may cover it, but you must meet income and asset limits that vary by state.
  • A nursing home must be Medicare-certified to accept Medicare payment; you can check this on Medicare.gov or by calling the facility directly.

What Medicare actually pays for in a nursing home

Medicare covers the cost of a bed, meals, and skilled nursing or therapy services in a Medicare-certified nursing home. This includes registered nurse care, licensed practical nurse care, physical therapy, occupational therapy, and speech therapy. It also covers medical equipment, supplies, and medications given during your stay. What it does not cover: a private room (unless medically necessary), a telephone, television, personal care items, or any custodial services.

The key word is skilled. If you are in a nursing home because you need wound care after surgery, physical therapy after a stroke, or monitoring for a new medication, Medicare may pay. If you are there because you cannot safely live alone and need someone to help you bathe and dress, Medicare will not pay — even if a nurse happens to work at that facility.

The three-day hospital stay requirement

Before Medicare will pay for a nursing home, you must have been admitted to a hospital and stayed for at least three consecutive calendar days. An observation stay does not count — you must be admitted as an inpatient. The three days must be consecutive, and the clock includes the day you are admitted and the day you are discharged, but not the day after discharge.

This rule trips up many people. If you go to the emergency room, spend 12 hours in observation, and are sent home, that does not count. You must be formally admitted to the hospital as an inpatient. Ask the hospital staff directly whether you are an inpatient or in observation — do not assume based on where you are physically located. You can also call Medicare at 1-800-MEDICARE to verify your status.

How long Medicare will pay and what you owe

Medicare covers up to 100 days of skilled nursing facility care per benefit period (a benefit period begins when you are admitted to a hospital and ends 60 days after you leave the nursing home). Here is what you pay:

  • Days 1–20: You pay nothing. Medicare covers 100 percent.
  • Days 21–100: You pay a daily copay. The amount changes each year; for 2024 it is $194.50 per day, but check Medicare.gov or call 1-800-MEDICARE for the current year.
  • Day 101 onward: You pay all costs. Medicare coverage ends.

If you need care beyond 100 days, you must pay out of pocket or turn to Medicaid if you meet the income and asset limits. Some people have supplemental insurance (Medigap) that covers part of the copay for days 21–100; check your policy.

When Medicaid takes over for long-term care

If you need a nursing home for longer than 100 days, or if you only need custodial care and not skilled care, Medicaid — not Medicare — is the program that may help. Medicaid is jointly funded by federal and state governments, and each state sets its own rules. Most states cover nursing home care for people who meet income and asset limits, but those limits vary widely.

To find out whether you might be covered by Medicaid, contact your state Medicaid office or call 1-800-MEDICARE and ask for a referral to your local Medicaid agency. You will need to provide information about your income, savings, property, and other assets. Some states allow you to keep a small amount of savings and a home; others have stricter limits. Planning ahead with an elder law attorney can sometimes help you understand your options, though this is not free.

How to find a Medicare-certified nursing home

Not all nursing homes accept Medicare. A facility must be Medicare-certified to bill Medicare for your care. You can search for certified facilities on Medicare.gov under "Care Providers" or by calling 1-800-MEDICARE. The search tool shows you the facility's name, location, phone number, and whether it is certified for skilled nursing care.

When you call a nursing home, ask directly: "Are you Medicare-certified?" and "Do you accept Medicare patients?" Some facilities are certified but do not actively admit Medicare patients, so asking both questions matters. If you are being discharged from a hospital, the hospital's discharge planner can also help you find a Medicare-certified facility nearby that has an available bed.

What happens if you run out of Medicare coverage

If you reach day 100 and still need care, Medicare stops paying. At that point, you have a few options: pay out of pocket if you can afford it, turn to Medicaid if you meet the income and asset limits, or explore other sources of payment. Some nursing homes offer payment plans or sliding-scale fees based on income, though this varies by facility.

If you have a Medigap supplemental insurance policy, check whether it covers nursing home costs beyond the 100-day limit. Some policies do; most do not. If you have long-term care insurance, review your policy to see what it covers and when benefits begin. The time to understand these options is before you need the care, not after you have used up your Medicare days.

Frequently Asked Questions

Does Medicare cover nursing home care without a hospital stay first?

No. Medicare requires a hospital admission of at least three consecutive days before it will pay for skilled nursing facility care. If you go directly from home to a nursing home, Medicare will not cover it. You would need to pay out of pocket or turn to Medicaid if you meet the income and asset limits.

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

A skilled nursing facility (SNF) is a type of nursing home that provides skilled medical care under the supervision of a nurse. Not all nursing homes are skilled nursing facilities; some provide only custodial care. Medicare only pays for care in a Medicare-certified skilled nursing facility, not in a custodial-care-only facility.

If I need a nursing home for more than 100 days, what do I do?

After 100 days, Medicare stops paying. You can pay out of pocket, turn to Medicaid if you meet income and asset limits, or check whether you have long-term care insurance or a Medigap policy that covers extended nursing home stays. Contact your state Medicaid office to learn about coverage options in your state.

Can I choose any nursing home I want if Medicare is paying?

You can choose any Medicare-certified skilled nursing facility that will accept you. Not all facilities are certified, and not all certified facilities have available beds or accept Medicare patients. Ask the facility directly whether it is Medicare-certified and whether it has an opening before you plan to move there.

Does Medicare cover the cost of living in a nursing home if I only need help with daily activities?

No. Medicare only covers skilled nursing care — care that must be provided by a nurse or therapist. Help with bathing, dressing, eating, and toileting is custodial care, and Medicare does not pay for it. Medicaid may cover custodial care in a nursing home if you meet your state's income and asset limits.