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

Medicare will pay for a nursing home stay, but not the kind most people think of. Medicare covers skilled nursing care — medical treatment you need after a hospital stay, like wound care, physical therapy, or medication management. It does not cover custodial care — help with daily living like bathing, dressing, or eating — which is what most long-term nursing home residents need.

The difference matters because it determines whether Medicare pays anything at all. If you need a nursing home mainly because you cannot care for yourself, Medicare will not cover it. If you need one because you are recovering from surgery or an acute illness and need skilled medical care, Medicare may cover it — for up to 100 days in a benefit period.

After that, you pay out of pocket, Medicaid takes over (if you meet income limits), or you rely on long-term care insurance if you have it. Understanding which type of care you need is the first step to knowing what to expect to pay.

Key Takeaways

  • Medicare covers skilled nursing care for up to 100 days per benefit period, but only if you were hospitalized for at least three days first.
  • You pay nothing for days 1–20, and a daily copay (currently $194.50 per day in 2024, though this changes yearly) for days 21–100.
  • Medicare does not cover custodial care — help with bathing, dressing, eating, or other daily activities — even in a nursing home.
  • If you need long-term care beyond 100 days, Medicaid or private payment becomes your only option, unless you have long-term care insurance.
  • The nursing home must be Medicare-certified and you must be admitted for a medical reason, not just because you need supervision or help at home.

What Medicare Covers in a Nursing Home

Medicare Part A covers a nursing home stay only if three conditions are met. First, you must have been hospitalized for at least three consecutive days before admission — an overnight stay in the emergency room does not count. Second, you must be admitted to a Medicare-certified skilled nursing facility within 30 days of hospital discharge. Third, a doctor must order the nursing home care as medically necessary for a condition related to your hospital stay.

What Medicare actually pays for includes nursing care, medications, medical equipment (like oxygen or a walker), therapy (physical, occupational, or speech), and meals. It does not include a private room unless medically necessary, or amenities like a telephone or television.

The length of coverage depends on how much skilled care you need. Medicare covers up to 100 days in a benefit period, but many people are discharged sooner once they improve enough to go home or to a lower level of care.

How Much You Pay Out of Pocket

For days 1 through 20, you pay nothing — Medicare covers the full cost. Starting on day 21, you pay a daily copay. In 2024, that copay is $194.50 per day, but this amount changes each year. You are responsible for this copay for each day you stay, from day 21 through day 100.

After day 100 in a benefit period, Medicare stops paying entirely. At that point, you must pay the full cost of the nursing home yourself, or Medicaid takes over if you meet your state's income and asset limits.

A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home. If you are readmitted to the hospital during that time, the clock does not reset — you are still in the same benefit period. Once 60 days pass without a hospital or nursing home stay, a new benefit period begins.

What Medicare Does Not Cover

Medicare does not cover custodial care, which is the main reason most people live in nursing homes long-term. Custodial care means help with activities of daily living: bathing, dressing, eating, toileting, and moving around. Even if a nursing home provides this care, Medicare will not pay for it.

Medicare also does not cover a nursing home stay if you are admitted for supervision, observation, or general decline — even if a doctor thinks a nursing home is the safest place for you. The stay must be for active medical treatment related to a recent hospitalization.

If you need a nursing home but do not meet Medicare's requirements, you have three options: pay privately, turn to Medicaid (if you may have access to), or use long-term care insurance if you have a policy.

The Difference Between Skilled Nursing and Custodial Care

Skilled nursing care requires a licensed nurse or therapist and is ordered by a doctor as part of treatment. Examples include wound dressing after surgery, intravenous medication, catheter care, physical therapy after a stroke, or speech therapy after a head injury. The care is time-limited and aimed at recovery or improvement.

Custodial care is help with daily living that does not require a medical license. A nursing home aide can provide it, and it is ongoing rather than temporary. Most people in nursing homes need custodial care, not skilled care. They may have dementia, mobility problems, or general frailty — conditions that require supervision and information but not active medical treatment.

A person can need both at the same time. If you are recovering from a hip fracture and also have dementia, Medicare will cover the skilled care (physical therapy) but not the custodial care (help dressing and bathing). You or your family must pay for the custodial portion.

When Your Medicare Coverage Ends

Your coverage ends when one of three things happens: you have used all 100 days in your benefit period, your doctor determines you no longer need skilled care, or the nursing home discharges you. The nursing home must give you written notice at least two days before discharge, and you have the right to appeal if you think you still need care.

If you disagree with the discharge decision, you can ask the nursing home to submit your case to a Quality Improvement Organization (QIO), which will review whether you still need skilled care. This review is free and does not delay your discharge, but it can result in Medicare continuing to pay while the review happens.

Once coverage ends, you become responsible for all costs. If you cannot afford to stay, the nursing home must help you find other options, such as a Medicaid-certified facility or home care services.

Medicaid as an Alternative for Long-Term Care

Medicaid is a joint federal-state program that covers long-term nursing home care, including custodial care, if you meet income and asset limits. Unlike Medicare, Medicaid has no time limit — it can cover years of nursing home care. However, Medicaid is means-tested, meaning you must have limited income and assets to may have access to.

Income and asset limits vary by state. In most states, your monthly income must be below a certain threshold (often around $2,000 to $2,500), and your assets must be under a limit (often around $2,000). Some assets, like your home and one vehicle, do not count toward the limit.

If you have too much income or assets to may have access to for Medicaid now, you may become may be able to access later as you spend down your savings on nursing home care. Many people plan for this by consulting an elder law attorney about how to protect assets while becoming Medicaid-may be able to access. This is a complex area with state-specific rules, so professional guidance is important.

Questions to Ask Your Doctor and the Nursing Home

Before admission, ask your doctor whether the nursing home stay is for skilled care or custodial care, and how long they expect you to need it. Ask the nursing home whether it is Medicare-certified and whether it accepts your Medicare plan. Request a written estimate of what Medicare will cover and what you will owe.

Ask the nursing home to explain the discharge plan — when and how they expect you to leave, and what happens if you cannot go home. Ask whether they can help you transition to Medicaid if your Medicare coverage ends and you cannot afford to stay. Get all important information in writing, including the notice of your rights and the facility's discharge policy.

If you receive a discharge notice you disagree with, ask the nursing home for the QIO contact information so you can request a review. Do not wait — you have limited time to appeal.

Frequently Asked Questions

Does Medicare cover nursing home care if I was not hospitalized first?

No. Medicare requires a hospital stay of at least three consecutive days before it will cover nursing home care. If your doctor sends you directly to a nursing home from home or from an outpatient clinic, Medicare will not pay for it. You would need to pay privately or use Medicaid if you may have access to.

What happens if I need nursing home care after day 100?

Medicare stops paying after 100 days in a benefit period. You then pay the full cost yourself, or Medicaid takes over if you meet your state's income and asset limits. Some people have long-term care insurance that covers this gap. Others deplete their savings and then become Medicaid-may be able to access.

Can I switch to a different nursing home and get another 100 days of Medicare coverage?

No. The 100-day limit applies to each benefit period, not to each facility. Moving to a different nursing home does not reset the clock. However, if you are discharged and then readmitted to the hospital, a new benefit period begins, which would give you another 100 days of coverage.

Does Medicare cover nursing home care for dementia or Alzheimer's disease?

Only if the nursing home stay is for skilled care related to a recent hospitalization. If you need a nursing home mainly because of dementia and cannot care for yourself, that is custodial care, which Medicare does not cover. Medicaid covers custodial care for dementia if you meet income and asset limits.

What if the nursing home says I am ready to leave but I do not think I am?

You can request a Quality Improvement Organization review at no cost. The nursing home must provide the QIO contact information. The QIO will review your medical records and determine whether you still need skilled care. While the review is pending, Medicare continues to pay, so there is no financial penalty for requesting one.