Medicare covers skilled nursing care in convalescent homes, but only after a hospital stay and only for specific medical needs

Medicare Part A covers up to 100 days in a skilled nursing facility (SNF) — the formal name for what many people call a convalescent home — but the coverage has strict conditions. You must have spent at least three consecutive days in a hospital first, you must be admitted to the SNF within 30 days of leaving the hospital, and the care you receive must be skilled nursing or rehabilitation that your doctor says you need because of the condition you were treated for in the hospital.

If you are moving to a convalescent home for custodial care — help with bathing, dressing, meals, or general supervision — Medicare does not pay. The difference matters because many convalescent homes provide both types of care, and which one you need determines what your costs will be.

Key Takeaways

  • Medicare Part A covers skilled nursing care in a convalescent home for up to 100 days, but only after a hospital stay of at least three days and only if the care is medically necessary.
  • You pay nothing for days 1 through 20, a daily coinsurance amount for days 21 through 100, and all costs after day 100.
  • The SNF must be Medicare-certified, and your doctor must order the skilled care — you cannot choose a convalescent home and have Medicare cover it retroactively.
  • Custodial care, including help with daily living activities and supervision, is never covered by Medicare and is your responsibility to pay for.
  • If you need long-term custodial care, Medicaid may cover it in some states, but rules vary widely and you will need to contact your state Medicaid office to learn what is available.

How the three-day hospital stay requirement works

The hospital stay must be three consecutive days as an inpatient — not counting the day you are discharged. If you spend three days in the hospital and are sent home on day four, you meet the requirement. If you are admitted for observation rather than as an inpatient, those days do not count, even if you stay longer than three days.

This distinction matters because hospitals sometimes admit patients under "observation status" instead of inpatient status. The hospital bills differently, and Medicare counts only inpatient days toward the three-day requirement. If you are unsure of your status, ask the hospital directly: "Am I admitted as an inpatient or under observation?" The answer determines whether you can move to a SNF with Medicare coverage.

You must be admitted to the SNF within 30 days of the day you leave the hospital. If you go home first and then decide a week later that you need skilled care, Medicare will not cover it unless you were readmitted to the hospital in the meantime.

What counts as skilled nursing care that Medicare will pay for

Skilled nursing care means medical care that requires a licensed nurse or therapist — not just any help with daily activities. Examples include wound care after surgery, intravenous medication, physical therapy, occupational therapy, speech therapy, and monitoring of a medical condition like heart failure or diabetes that requires professional judgment.

The care must be related to the condition you were hospitalized for. If you were hospitalized for a hip fracture and need physical therapy to walk again, Medicare covers that. If you were hospitalized for pneumonia, recovered, and now need help bathing because you are weak, that is custodial care and Medicare does not cover it — even though you are in a SNF.

Your doctor must order the skilled care, and the SNF must document that it is medically necessary. You cannot move to a convalescent home and ask them to bill Medicare for care you think you need. The SNF will assess you when you arrive and tell you whether the care you need qualifies as skilled care under Medicare rules.

How much you pay out of pocket

For days 1 through 20 in a SNF, you pay nothing if Medicare is covering the stay. Medicare Part A pays the full cost.

For days 21 through 100, you pay a daily coinsurance amount. This amount changes each year — it is set at one-eighth of the Part A hospital deductible. In 2024, the daily coinsurance is $200 per day, but confirm the current amount with Medicare or your SNF because it increases annually.

After day 100, Medicare pays nothing. You are responsible for all costs. Some people have Medigap insurance (supplemental coverage) that helps pay the coinsurance for days 21 through 100, and a few Medigap plans cover some costs after day 100, but coverage varies by plan.

The difference between Medicare-certified and non-certified facilities

Medicare only covers care in a facility that is Medicare-certified as a skilled nursing facility. Not all convalescent homes are certified. Before you or your hospital discharge planner chooses a facility, confirm that it is Medicare-certified. You can search for certified facilities on Medicare.gov using their Nursing Home Compare tool, or call Medicare at 1-800-MEDICARE to ask whether a specific home is certified.

If you move to a non-certified facility, Medicare will not pay anything, even if the care you receive is skilled nursing care. You will pay the full cost yourself. Some non-certified facilities are less expensive, but you lose Medicare coverage entirely, so the savings may not be real.

What happens when your 100 days end

If you still need skilled nursing care after 100 days, Medicare Part A does not cover additional days. You must pay out of pocket, move to a different setting, or go home with home health care if your doctor says that is medically appropriate.

Home health care is covered by Medicare Part A if a doctor orders it, you are homebound, and the care is skilled nursing or therapy. Many people transition from a SNF to home health care when their 100 days end, which can be less expensive and allows you to recover at home.

If you need long-term custodial care in a facility after your Medicare coverage ends, Medicaid may cover it in your state, but rules vary significantly. Some states cover nursing home care for people with low income and assets; others do not. Contact your state Medicaid office or your local Area Agency on Aging to learn what options exist where you live.

How to prepare for a SNF stay and understand your costs

Before you are discharged from the hospital, ask the discharge planner whether your doctor has ordered skilled nursing care and whether a SNF stay is medically necessary. If the answer is yes, ask which facilities are Medicare-certified and accept your insurance. If you have a Medigap plan, tell the planner — some facilities work more closely with certain plans.

Ask the SNF directly what your daily coinsurance will be and how long they expect you to stay. They cannot predict exactly, but they can give you a range based on your condition and the therapy you need. Ask whether they will bill your Medigap insurance directly or whether you will need to submit the bill yourself.

Keep copies of your hospital discharge papers, your doctor's orders for skilled care, and any documents the SNF gives you about your stay. These documents matter if there is a dispute later about what Medicare should cover.

Frequently Asked Questions

Can Medicare cover a convalescent home stay if I was not hospitalized first?

No. Medicare Part A requires a three-day hospital stay as an inpatient before it will cover a SNF stay. If you need skilled nursing care but have not been hospitalized, Medicare will not pay. You would need to pay out of pocket or explore whether Medicaid covers it in your state.

What if the convalescent home says I need custodial care, not skilled care?

If the SNF determines that you need only custodial care — help with bathing, dressing, meals, or supervision — Medicare will not cover your stay, even if you meet the hospital requirement. You will be responsible for all costs. Ask the SNF to explain in writing why they believe the care is custodial, and ask your doctor whether skilled care is medically necessary.

Does Medicare cover convalescent home care if I have Original Medicare and a Medigap plan?

Original Medicare Part A covers the same skilled nursing care with or without Medigap. The Medigap plan may help pay your daily coinsurance for days 21 through 100, depending on which plan you have. Some Medigap plans cover all the coinsurance; others cover part of it. Check your plan documents or call your Medigap insurer to confirm what your plan covers.

What if I want to stay longer than 100 days?

Medicare will not extend coverage beyond 100 days. If you still need skilled care, you must pay out of pocket, move to a different facility, or transition to home health care if your doctor orders it. Some people use long-term care insurance or Medicaid to cover extended stays, but you will need to contact those programs directly to learn whether you are covered.

Can I choose any convalescent home I want and have Medicare pay?

No. The facility must be Medicare-certified, your doctor must order the skilled care, and you must meet the hospital requirement. You can choose among Medicare-certified facilities, but Medicare will only pay if all three conditions are met. If you choose a non-certified facility, Medicare will not pay anything.