Medicare covers some nursing home costs, but only under specific conditions and only for a limited time
Medicare will pay for a skilled nursing facility (SNF) stay — a nursing home that provides medical care — but not for custodial care, which is help with daily living like bathing and dressing. The difference matters because it determines whether Medicare pays anything at all. You must first spend at least three days in a hospital, be admitted to the SNF within 30 days of leaving the hospital, and have a doctor say you need skilled care related to the condition you were treated for in the hospital. If you meet those conditions, Medicare covers the full cost of the first 20 days. From day 21 to day 100, you pay a daily amount (in 2024, that is $194 per day) and Medicare covers the rest. After day 100 in the same benefit period, Medicare pays nothing.
The key word here is skilled. A nursing home that only helps you bathe, dress, and eat is not a skilled nursing facility, and Medicare will not pay for it. A facility that provides wound care, physical therapy, IV medications, or medical monitoring is a skilled nursing facility, and Medicare may cover it — but only if you meet the hospital stay requirement and the care is related to why you were hospitalized.
Key Takeaways
- Medicare only covers skilled nursing facility care after a hospital stay of at least three days, and only if the care is related to what you were treated for in the hospital.
- You pay nothing for days 1–20, then a daily copay for days 21–100, and nothing is covered after day 100 in the same benefit period.
- Custodial care — help with bathing, dressing, and toileting — is never covered by Medicare, even in a nursing home.
- If you need nursing home care without a hospital stay first, or if you need care after day 100, you will need to pay out of pocket or look into Medicaid.
The three-day hospital stay requirement
You must spend at least three consecutive days in a hospital before Medicare will cover a nursing home stay. The clock starts when you are admitted as an inpatient — not when you arrive in the emergency room or observation unit. Many people spend time in the hospital on "observation status" rather than as an inpatient, and observation days do not count toward the three-day requirement. Ask the hospital staff directly whether you are admitted as an inpatient or on observation status; the difference is not always clear from the paperwork.
The three-day stay must happen within 30 days before you enter the nursing home. If you are discharged from the hospital and wait 31 days before going to the SNF, Medicare will not cover it. You do not have to go directly from the hospital to the nursing home — you can go home first — but the 30-day window is firm. Keep your hospital discharge papers, because the nursing home will ask for proof of your inpatient admission date when you explore for coverage.
What "skilled care" means and why it matters
Skilled nursing care is medical care that must be given by a nurse or under a nurse's supervision — wound care, physical therapy, medication management, or monitoring of a medical condition. Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, and moving around. Medicare covers skilled care; it does not cover custodial care, even if you receive it in a nursing home.
The skilled care must also be related to the condition you were treated for in the hospital. If you were hospitalized for pneumonia and need IV antibiotics and breathing treatments in the nursing home, that is covered. If you were hospitalized for pneumonia but now need help with bathing because you have arthritis, the bathing help is not covered — it is custodial care unrelated to the pneumonia. A doctor must order the skilled care and document that it is medically necessary.
How much Medicare pays and what you pay
| Days in SNF | What Medicare Pays | What You Pay |
|---|---|---|
| 1–20 | 100% of approved charges | $0 |
| 21–100 | All charges above the daily copay | $194 per day (2024) |
| 101+ | $0 | All charges |
The daily copay amount changes each year. The nursing home will tell you the exact amount when you are admitted. The copay covers all services — room, board, nursing care, therapy, and medications — so there are no separate bills once you know the daily amount.
These costs explore only during a single "benefit period." A benefit period starts when you enter the hospital and ends after you have gone 60 days without being an inpatient in a hospital or SNF. Once a benefit period ends, a new one begins, and your day count resets to 1. This means if you leave the nursing home, stay home for 60 days, and then return to a nursing home after another hospital stay, you start over at day 1 with no copay.
When Medicare does not cover nursing home care
Medicare will not pay if you need a nursing home but have not had a hospital stay first. Some people go directly from home to a nursing home because they need help with daily living or ongoing medical monitoring. If there was no hospital admission, Medicare does not cover it, even if a doctor says you need care. You would need to pay out of pocket or look into Medicaid, which has different rules and may cover custodial care.
Medicare also does not cover care after day 100 in the same benefit period, no matter how medically necessary it is. If you need to stay longer, you pay the full cost yourself unless Medicaid covers you or you have a supplemental insurance policy that includes nursing home coverage. Some people plan for this by looking into Medicaid rules before they need a nursing home, so they understand their options if a stay runs past 100 days.
Medicaid and other ways to pay for longer stays
Medicaid is a joint federal and state program that covers nursing home care, including custodial care, for people with low income and limited assets. Medicaid rules vary by state, but generally you must have less than $2,000 in countable assets (the limit is higher for married couples). Medicaid can cover care for as long as you need it, not just 100 days. Some people use Medicare to cover the first 100 days and then switch to Medicaid for longer stays.
If you have a Medigap policy (supplemental insurance) or a Medicare Advantage plan, check your policy documents or call the plan to ask whether it covers nursing home care beyond what Medicare covers. Some do; many do not. Long-term care insurance, if you have it, may also help pay for extended nursing home stays. Ask your insurance agent or call the customer service number on your policy card to find out what your plan covers.
How to prepare before you need a nursing home
Ask your doctor now whether you have any conditions that might require nursing home care later — heart disease, stroke, dementia, or arthritis that limits mobility. If you do, talk to your doctor about what kind of care you might need and whether it would be skilled care (covered by Medicare) or custodial care (not covered).
Look into your state's Medicaid rules for nursing home coverage, even if you think you have enough money now. Medicaid planning can be complex, and it helps to understand the rules before a crisis forces a quick decision. You can also ask a social worker at your hospital or doctor's office about nursing home costs and payment options; many hospitals have discharge planners who help with these questions. Starting these conversations early gives you time to understand your options and make informed decisions.
Frequently Asked Questions
Can I use Medicare to pay for a nursing home if I did not have a hospital stay?
No. Medicare requires a hospital stay of at least three days before it will cover nursing home care. If you need a nursing home without a hospital stay, you will need to pay out of pocket or look into Medicaid, which has different rules and does not require a hospital stay first.
What happens if I stay in the nursing home past day 100?
Medicare stops paying after day 100 in the same benefit period. You will owe the full cost of care from day 101 onward unless Medicaid covers you, you have supplemental insurance, or you pay privately. A new benefit period begins 60 days after you leave the hospital or nursing home, which resets your day count.
Does Medicare cover the cost of living in an assisted living facility?
No. Medicare only covers skilled nursing facilities, not assisted living. Assisted living provides help with daily activities but not skilled medical care. You pay for assisted living out of pocket or through Medicaid in some states.
If my doctor says I need custodial care in a nursing home, will Medicare pay?
No. Medicare does not cover custodial care — help with bathing, dressing, eating, and toileting — even if a doctor orders it and you are in a nursing home. Only skilled nursing care is covered. If you need only custodial care, Medicaid may cover it if you meet income and asset limits.
Can I appeal if Medicare denies coverage for my nursing home stay?
Yes. If Medicare denies coverage, you have the right to ask for a review. The nursing home or your doctor can help you file an appeal. You have 120 days from the date of the denial notice to request an appeal. Contact Medicare at 1-800-MEDICARE or ask the nursing home's billing department for help.