Medicare covers some nursing home costs, but only under specific conditions — and only for a limited time
Medicare will pay for a nursing home stay, but not the way many people think. It does not cover long-term custodial care (help with daily activities like bathing and dressing). Instead, Medicare covers skilled nursing care — medical treatment that requires a nurse or therapist — for up to 100 days after a hospital stay. After that, you pay the full cost yourself, or Medicaid takes over if you meet income and asset limits.
The difference matters enormously. If you need a nursing home because you can no longer live alone but do not need daily medical treatment, Medicare will not pay. If you need wound care, physical therapy, or intravenous medication after leaving the hospital, Medicare will cover it — but only if you were hospitalized first, and only while you are making progress toward recovery.
Key Takeaways
- Medicare covers skilled nursing care for up to 100 days only after a hospital stay of at least three days.
- You pay nothing for days 1–20, a copay of about $200 per day for days 21–100 (the amount changes yearly), and the full cost after day 100.
- Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting — even if you live in a nursing home.
- Medicaid covers long-term nursing home stays if you have limited income and assets, but rules vary by state.
- Long-term care insurance, if you have it, may cover costs that Medicare and Medicaid do not.
The three-day hospital stay requirement
Medicare will only pay for a nursing home stay if you were hospitalized for at least three consecutive days first. The stay must be for the same condition or a related one. A three-day observation stay in the hospital does not count — it has to be an inpatient admission.
This rule trips up many people. You might spend four days in the hospital and think you are covered for a nursing home afterward. But if the hospital counts those days as "observation" rather than "inpatient," Medicare will not cover the nursing home. Ask the hospital billing department directly whether you were admitted as an inpatient, not just whether you stayed three days.
Once you meet the three-day requirement, the clock for nursing home coverage starts the day you are admitted to the nursing home, not the day you left the hospital. If you go home first and then enter a nursing home weeks later, you do not may have access to.
What Medicare pays and what you pay
Medicare covers the full cost of skilled nursing care for the first 20 days after you enter the nursing home. Starting on day 21, you pay a copay for each day. That copay changes every year; in 2024 it is about $200 per day, but check your Medicare Summary Notice or call Medicare at 1-800-MEDICARE to confirm the current amount.
After day 100, Medicare stops paying entirely. You then pay the full nursing home bill yourself, unless Medicaid takes over. Nursing homes in the United States charge anywhere from $100 to $300 per day on average, though costs vary widely by location and facility type.
The 100-day limit resets only if you leave the nursing home for at least 60 days and then return after another may have access to hospital stay. If you stay in the nursing home continuously past day 100, you will owe the full cost from that point forward.
Skilled nursing care versus custodial care
The line between skilled care and custodial care determines whether Medicare pays. Skilled care is medical treatment that must be given by or under the supervision of a nurse or therapist. Examples include wound dressing changes, catheter care, physical therapy, occupational therapy, speech therapy, and intravenous medication.
Custodial care is help with activities of daily living: bathing, dressing, eating, toileting, and moving around. Even if a nurse provides this help, it is still custodial care, and Medicare does not cover it. Many people enter nursing homes because they need custodial care, not skilled care, which is why Medicare does not pay for their stay.
Medicare reviews your care plan regularly. If you stop making progress toward recovery — for example, if your physical therapy plateaus and you are unlikely to return home — Medicare may stop paying even before day 100. The nursing home must notify you in writing if Medicare coverage is ending.
When Medicaid covers nursing home care instead
Medicaid, the joint federal-state program for low-income people, covers long-term nursing home stays with no time limit. Unlike Medicare, Medicaid pays for custodial care. However, Medicaid has strict rules about income and assets, and these rules differ by state.
Generally, you must have monthly income below a certain threshold (often around $2,000 to $2,500, depending on the state) and countable assets below a limit (often around $2,000). Your home, one car, and some personal items do not count toward the asset limit, but savings, investments, and a second property do.
If you have too much income or too many assets to may have access to for Medicaid now, you may be able to spend down your resources to become may be able to access. Some people use a strategy called a "Medicaid trust" to protect assets, but these are complex and require legal help. Contact your state Medicaid office or a legal aid organization to understand the rules in your state.
Long-term care insurance and other payment sources
If you bought a long-term care insurance policy before entering a nursing home, it may cover costs that Medicare and Medicaid do not. These policies vary widely in what they cover, how much they pay per day, and how long benefits last. Check your policy documents or call your insurance company to see what your coverage includes.
Some people pay for nursing home care out of pocket using savings, retirement accounts, or help from family. Others use a combination: Medicare for the first 100 days, then Medicaid if they may have access to, then personal funds or long-term care insurance for anything beyond that.
Veterans and their surviving spouses may be may be able to access for Aid and Attendance benefits through the Department of Veterans Affairs, which can help pay for nursing home care. Contact the VA or a veterans service organization to learn whether you may have access to.
Planning ahead for nursing home costs
Because Medicare covers nursing home care only briefly and under strict conditions, many people plan ahead. Long-term care insurance, purchased while you are healthy, can cover costs that Medicare will not. Some people set aside savings specifically for potential nursing home care.
If you are already facing a nursing home stay, ask the facility's social worker or financial counselor about payment options. They can explain what Medicare will cover in your specific situation, help you understand Medicaid rules in your state, and discuss payment plans or financial information programs the facility may offer.
Having these conversations early — before a health crisis — gives you time to understand your options and make decisions that fit your values and finances.
Frequently Asked Questions
Will Medicare pay if I need a nursing home but was never hospitalized?
No. Medicare requires a hospital stay of at least three days as an inpatient before it will cover nursing home care. If you go directly from home to a nursing home, Medicare will not pay, even if you need skilled care. Medicaid may cover you if you meet income and asset limits.
What happens on day 101 if I am still in the nursing home?
You become responsible for the full cost. If you may have access to for Medicaid, it may take over the bill at that point, but you must have already applied and been approved. If you do not may have access to for Medicaid and have no other payment source, you will need to pay out of pocket or work with the nursing home on a payment plan.
Can I appeal if Medicare stops paying before day 100?
Yes. If you disagree with Medicare's decision to stop coverage, you have the right to appeal. The nursing home must give you written notice before coverage ends, and that notice explains how to appeal. You can also ask your doctor or the nursing home to request a review of the decision.
Does Medicare cover assisted living or memory care facilities?
No. Medicare only covers skilled nursing facilities (nursing homes), not assisted living, memory care units, or independent senior housing. These facilities provide custodial care, which Medicare does not cover. Medicaid may cover some assisted living in certain states, but rules vary.
If I have both Medicare and Medicaid, which one pays first?
Medicare pays first for skilled nursing care during the first 100 days after a hospital stay. After Medicare coverage ends or if you need custodial care, Medicaid takes over if you may have access to. The nursing home will bill Medicare first, then Medicaid for any remaining costs.