Medicare covers some nursing home costs, but only under specific conditions — and the coverage is temporary, not permanent
Medicare will pay for a stay in a skilled nursing facility (SNF) if you meet strict requirements: you must have been admitted to a hospital for at least three consecutive days, move to the nursing home within 30 days of hospital discharge, and need daily skilled nursing or rehabilitation services. The facility must also be Medicare-certified. If all those conditions are met, Medicare covers the full cost of the first 20 days, then requires you to pay a daily coinsurance amount (currently $194.50 per day in 2024, though this changes yearly) for days 21 through 100. After 100 days in the same benefit period, you pay all costs yourself.
Medicare does not cover custodial care — help with bathing, dressing, meals, or daily living — unless it is part of a skilled nursing plan. It also does not cover a permanent move to a nursing home for ongoing information. Many people assume Medicare will cover long-term nursing home care the way it covers a hospital stay. It will not. If you need help beyond 100 days, or if you do not meet the hospital-stay requirement, you will need to pay out of pocket, use Medicaid, or rely on long-term care insurance.
Key Takeaways
- Medicare covers a nursing home stay only if you spent at least three consecutive days in a hospital first and move to a Medicare-certified facility within 30 days.
- Medicare pays the full cost for the first 20 days, then you pay a daily amount (currently $194.50 per day) for days 21 through 100 in the same benefit period.
- After 100 days, Medicare stops paying and you must cover all costs yourself, which is why many people turn to Medicaid or long-term care insurance.
- Medicare does not cover custodial care such as help with bathing or dressing unless it is ordered as part of a skilled nursing recovery plan.
- The three-day hospital stay requirement is strict — observation stays do not count, only admitted stays.
The Three-Day Hospital Stay Requirement
The first condition is the hardest to meet: you must have been admitted to a hospital for at least three consecutive days before Medicare will cover a nursing home stay. This means you were assigned a hospital bed and a hospital room number. An observation stay — where you are in the hospital but not formally admitted — does not count, even if you spend three days there. Many people spend three days in observation and then are told they do not meet the requirement.
The three days must be consecutive calendar days, not three 24-hour periods. If you are admitted on a Monday and discharged on a Wednesday, that counts as three days. You must then move to the nursing home within 30 days of leaving the hospital. If you go home first and wait two months before entering a nursing home, Medicare will not cover it.
Ask the hospital before you are discharged whether you were admitted or on observation status. If you were on observation and believe the decision was wrong, you can request an expedited review through the hospital's patient advocate office. This does not always change the decision, but it is worth asking.
What Medicare Pays and What You Pay
If you meet the hospital requirement and enter a Medicare-certified nursing home within 30 days, here is how the payment works:
| Days in Facility | What Medicare Pays | What You Pay |
|---|---|---|
| Days 1–20 | 100% of covered costs | $0 |
| Days 21–100 | All costs except daily coinsurance | $194.50 per day (2024 amount) |
| Day 101 and beyond | $0 | 100% of all costs |
The daily coinsurance amount changes each year. The nursing home will tell you the current amount when you are admitted. Some people have supplemental insurance (Medigap) that covers part or all of the daily coinsurance, so check your policy before you arrive.
These payments cover room, board, meals, nursing care, medications, and rehabilitation services ordered by a doctor. They do not cover private-duty nurses, television, phone service, or items the facility considers non-medical.
Skilled Nursing Versus Custodial Care
Medicare only pays for skilled nursing care — services that require a nurse or therapist and are ordered by a doctor. This includes wound care, intravenous medications, physical therapy, occupational therapy, and speech therapy. It also includes nursing observation and assessment when you are recovering from an acute illness or injury.
Medicare does not pay for custodial care — help with bathing, dressing, toileting, eating, or moving around — unless a nurse or therapist is providing it as part of a skilled nursing plan. For example, if you are in a nursing home for physical therapy after a hip replacement, and a nurse helps you bathe as part of your recovery, that is covered. If you are in a nursing home because you can no longer bathe yourself and need ongoing help, that is custodial care and Medicare will not pay for it.
The nursing home's care plan will specify which services are skilled and which are custodial. If you disagree with that classification, you can ask the facility's social worker or contact your state's long-term care ombudsman.
When Medicare Coverage Ends
Medicare coverage ends in three situations: when you have been in the facility for 100 days in the same benefit period, when you no longer need skilled nursing care, or when your doctor determines you are not making progress toward recovery.
A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home. If you leave the nursing home, go home for 60 days, and then return to a nursing home, a new benefit period starts and you get another 100 days of coverage. However, if you return within 60 days, you are still in the same benefit period and your day count continues from where it left off.
The nursing home must notify you in writing before it stops providing skilled care or before day 100 approaches. If you believe the decision to stop coverage is wrong, you have the right to appeal. Ask the nursing home social worker how to file an appeal.
Medicaid as an Alternative When Medicare Runs Out
When Medicare coverage ends after 100 days, many people turn to Medicaid to cover ongoing nursing home costs. Medicaid is a joint federal and state program that covers long-term care, including custodial care in a nursing home, for people with limited income and assets. Unlike Medicare, Medicaid has no day limit — it can cover years of nursing home care.
However, Medicaid has strict financial limits. In most states, you must have less than $2,000 in countable assets (the limit varies slightly by state) and monthly income below a certain threshold. If you have more than that, you must spend down your savings until you may have access to. Some people use a Medicaid planning attorney to structure their finances in a way that preserves assets for a spouse while allowing the nursing home resident to may have access to.
Medicaid also pays nursing homes a lower daily rate than Medicare, so not all facilities accept Medicaid. Ask the nursing home whether it accepts Medicaid before you are admitted, and ask again as your Medicare coverage approaches its end.
Long-Term Care Insurance and Out-of-Pocket Costs
Some people have long-term care insurance, which is a separate policy designed to cover nursing home costs that Medicare and Medicaid do not. If you have this policy, check the details before you are admitted to see what it covers and what you must pay out of pocket. Long-term care insurance can significantly reduce your costs, but it is expensive and many people do not have it.
If you do not have long-term care insurance and do not may have access to for Medicaid, you will pay all nursing home costs yourself after Medicare coverage ends. Nursing home costs vary widely by location and facility type, but average around $100 to $150 per day for a semi-private room in most areas. Some facilities charge much more. Ask for a detailed cost estimate before you are admitted.
Some people move to a less expensive facility or to a different state where costs are lower. Others move back home and hire home health aides. These are difficult decisions, and a social worker at the nursing home can help you explore options.
Frequently Asked Questions
Does Medicare cover nursing home care if I was never in a hospital?
No. Medicare only covers a nursing home stay if you were admitted to a hospital for at least three consecutive days first. If you go directly from home to a nursing home, Medicare will not pay. You would need to pay out of pocket or use Medicaid if you may have access to.
Does an observation stay count toward the three-day requirement?
No. You must be formally admitted to the hospital, not on observation status. Ask the hospital before discharge which status you have. If you were on observation and think it was wrong, request an expedited review through the patient advocate office.
What happens if I leave the nursing home and come back within 60 days?
You are still in the same benefit period, so your day count continues. If you used 30 days before you left, you have 70 days remaining when you return. If you stay away for more than 60 days, a new benefit period starts and you get another 100 days.
Can I appeal if Medicare says I no longer need skilled care?
Yes. You have the right to appeal the decision. Ask the nursing home social worker or your doctor how to file an appeal. You can also contact your state's long-term care ombudsman for help.
Will Medicaid cover me if I have too much money for Medicare to pay?
Medicaid has its own income and asset limits, which are lower than Medicare's. If you have more than the Medicaid limit (usually around $2,000 in countable assets), you must spend down your savings first. A Medicaid planning attorney can advise you on how to do this while protecting assets for a spouse.