Medicare covers some nursing home care, but only under specific conditions and for a limited time

Medicare will pay for skilled nursing care in a nursing home, but only if you meet strict requirements: you must have been hospitalized for at least three consecutive days, admitted to the nursing home within 30 days of leaving the hospital, and need daily skilled care (like wound dressing, physical therapy, or medication management) that cannot be done at home. Even when all these conditions are met, Medicare pays in full for days 1–20, then requires you to pay a daily coinsurance amount for days 21–100. After day 100 in a benefit period, Medicare stops paying entirely.

Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting — which is what most long-term nursing home residents actually need. If you need a nursing home mainly because you cannot care for yourself but do not need skilled medical care, Medicare will not pay. This is the gap that catches most families unprepared.

Key Takeaways

  • Medicare covers skilled nursing care only after a hospital stay of at least three consecutive days, and only for up to 100 days per benefit period.
  • You must enter the nursing home within 30 days of hospital discharge, and the care you receive must be ordered by your doctor as a continuation of hospital treatment.
  • Medicare pays the full cost for days 1–20, then you pay a daily coinsurance amount (currently $200 per day, though this changes yearly) for days 21–100.
  • Custodial care — the daily help with bathing, dressing, and toileting that most long-term residents need — is never covered by Medicare, no matter how long you stay.
  • Medicaid, long-term care insurance, and your own savings are the main sources of payment for care beyond Medicare's 100-day limit.

The three-day hospital stay requirement and why it matters

The three-day rule is the first gate. You must spend at least three consecutive days as an inpatient in a hospital — not in the emergency room, not as an outpatient, but admitted to a hospital bed. Observation stays do not count, even if you are in the hospital for three days. This distinction trips up many people: you can be in a hospital for four days on observation status and still not meet the requirement.

The hospital stay must be for the same condition (or a related one) that requires the nursing home care. If you are hospitalized for pneumonia and then need a nursing home for physical therapy to recover from pneumonia, that qualifies. If you are hospitalized for pneumonia and then need a nursing home because you have dementia and cannot live alone, that does not may have access to — the nursing home care is not a continuation of hospital treatment for pneumonia.

Ask the hospital before discharge whether your stay counts as inpatient or observation. If you are unsure, request a written statement from the hospital billing department. This document matters later if Medicare denies the claim.

How long Medicare pays and what you owe on each day

Medicare divides the 100-day period into two tiers. Days 1 through 20 are fully covered — you pay nothing except your regular Medicare Part A deductible (which applies to the hospital stay, not the nursing home). Starting on day 21, you enter the coinsurance period and begin paying a daily amount out of pocket. For 2024, that daily coinsurance is $200, but the amount changes each year.

The 100-day limit resets on October 1 each year (the start of a new benefit period). If you use 60 days in one benefit period and are discharged, then readmitted after October 1, you get a fresh 100 days. But if you are readmitted before October 1, those days count toward your remaining balance from the previous period.

After day 100, Medicare pays nothing. You must then cover the full cost yourself, switch to Medicaid (if you meet income and asset limits), or rely on long-term care insurance if you have it. Many families do not realize this cliff until they hit it.

Skilled care versus custodial care — the distinction Medicare makes

Medicare distinguishes between skilled care and custodial care, and this distinction determines whether you are covered at all. Skilled care is medical or therapeutic care that requires a trained professional: wound care, physical therapy, occupational therapy, speech therapy, intravenous medications, catheter management, or nursing assessment for complex medical conditions. Custodial care is help with activities of daily living: bathing, dressing, eating, toileting, grooming, and transferring in and out of bed.

Many nursing home residents need both. Medicare will pay for the skilled portion but not the custodial portion. In practice, this means Medicare may cover the cost of a physical therapist's visit but not the cost of the aide who helps you bathe and dress every day. If you need only custodial care — which is the case for many people with dementia or advanced age — Medicare covers nothing.

The nursing home must document that you need skilled care and that the care is improving your condition or maintaining it at a level that would otherwise decline. If your condition is stable and not improving, Medicare may stop paying even if you are still receiving skilled services. This is why nursing homes often discharge patients after a few weeks: once improvement plateaus, Medicare coverage ends.

What happens when Medicare coverage ends

When you reach day 100 or when Medicare determines you no longer need skilled care, the nursing home must notify you in writing. At that point, you become responsible for the full daily cost, which varies widely by location and facility but typically ranges from $100 to $300 per day or more.

Some people transition to Medicaid at this point. Medicaid covers long-term custodial care in nursing homes, but only if your income and assets fall below your state's limits. The asset limit is often $2,000 for an individual, though rules vary by state. If you have savings or other assets above this threshold, you must spend them down before Medicaid begins paying. This process is called "spend-down" and can take months.

Others rely on long-term care insurance, if they purchased a policy before entering the nursing home. Some pay out of pocket until savings are exhausted, then explore for Medicaid. A few have family members who contribute. There is no single path; it depends on your financial situation and what coverage you have in place.

How to verify Medicare will cover your nursing home stay

Before you are discharged from the hospital, ask the hospital discharge planner whether your stay qualifies for Medicare-covered skilled nursing care. Get this in writing. The hospital should also provide a document called the "Important Message About Your Rights and Protections" (also called the "Detailed Notice of Discharge"), which explains Medicare coverage and your right to appeal if you disagree with the information.

When you arrive at the nursing home, the facility will submit a claim to Medicare on your behalf. You do not need to do this yourself. The nursing home will also provide you with a notice of Medicare coverage, which states how many days Medicare will cover. Read this carefully and ask questions if the number seems wrong.

If Medicare denies coverage or approves fewer days than you expected, you have the right to appeal. The notice will explain how to file an appeal and the important date (usually 120 days from the date of the notice). Many people do not appeal because they do not realize they can, or because they do not understand the process. If you believe the denial is wrong, contact your state's Patient Advocate Foundation or your local Area Agency on Aging for help filing an appeal.

Alternatives when Medicare does not cover your nursing home care

If you do not meet the three-day hospital stay requirement, or if you need only custodial care, Medicare will not pay. Your options are then Medicaid, long-term care insurance, private pay, or a combination.

Medicaid is a joint federal-state program that covers long-term nursing home care for people with low income and limited assets. Each state sets its own rules, but most require you to have less than $2,000 in countable assets and a monthly income below a certain threshold (often around $2,500, though this varies). Medicaid covers both skilled and custodial care, and there is no 100-day limit. However, the process process is lengthy, and you may need to spend down assets before you may have access to.

Long-term care insurance is a private insurance policy you purchase before you need care. It covers nursing home stays, assisted living, and sometimes home care. Policies vary widely in what they cover and how much they pay per day. If you have this insurance, the nursing home can bill it directly. Most people do not have this coverage because it is expensive and must be purchased years in advance.

Private pay means paying the nursing home directly from your savings, Social Security, pension, or family contributions. This works until your money runs out, at which point you may transition to Medicaid if you meet the requirements.

Frequently Asked Questions

Can I use Medicare to stay in a nursing home if I did not have a hospital stay first?

No. Medicare requires a hospital stay of at least three consecutive days as an inpatient before it will cover nursing home care. If you enter a nursing home directly from home or from an assisted living facility, Medicare will not pay, regardless of how much skilled care you need. You would need to pay privately, use Medicaid (if you may have access to), or rely on long-term care insurance.

What if I am in the hospital on observation status instead of as an inpatient?

Observation status does not count toward the three-day requirement, even if you are in the hospital for several days. Ask the hospital before discharge whether you are an inpatient or on observation. If you are on observation and then discharged to a nursing home, Medicare will not cover the nursing home stay. You can appeal this information if you believe it is wrong.

Does Medicare cover assisted living facilities?

No. Medicare covers only skilled nursing facilities (nursing homes), and only under the conditions described above. Assisted living is a different level of care and is not covered by Medicare. You would need to pay privately or use Medicaid if you may have access to.

What if I need nursing home care after day 100?

Medicare stops paying after day 100 in a benefit period. At that point, you must cover the cost yourself, transition to Medicaid (if you meet income and asset limits), or use long-term care insurance if you have it. Some people continue to live in the same nursing home and pay privately; others move to a facility that accepts Medicaid.

Can I appeal if Medicare denies coverage for my nursing home stay?

Yes. You have the right to appeal within 120 days of receiving the denial notice. The notice will explain how to file an appeal. Contact your state's Patient Advocate Foundation, your local Area Agency on Aging, or a legal aid organization for help with the appeal process if you need it.