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 way many people think. It does not cover custodial care — help with daily living like bathing, dressing, and meals — which is what most nursing home residents need long-term. Medicare only pays for skilled nursing care, which means medical treatment that requires a nurse or therapist: wound care, physical therapy after surgery, intravenous medications, or monitoring after a hospital stay. And it pays for only up to 100 days per benefit period, with your costs rising sharply after day 20.
The key requirement is that you must have been in a hospital for at least three consecutive days before the nursing home stay begins. A three-day observation stay does not count — it has to be an inpatient admission. If you go straight from home or an outpatient procedure to a nursing home, Medicare will not cover it at all.
Key Takeaways
- Medicare covers skilled nursing care (medical treatment by nurses or therapists) for up to 100 days per benefit period, but only if you were hospitalized as an inpatient for at least three consecutive days first.
- Medicare pays the full cost of days 1 through 20, but you pay a daily copay starting on day 21, and you pay all costs after day 100.
- Custodial care — help with bathing, dressing, meals, and toileting — is never covered by Medicare, even in a nursing home, and is the reason most people need long-term nursing home placement.
- If you need ongoing nursing home care after Medicare stops paying, Medicaid may cover it, but only if your income and assets fall below your state's limits.
- You should ask your hospital discharge planner which nursing homes accept Medicare and whether your specific condition qualifies for skilled care before you are discharged.
How Medicare's 100-Day Benefit Works
When Medicare covers a nursing home stay, it is tied to what Medicare calls a benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the hospital or nursing home, whichever is later. During that benefit period, Medicare will pay for up to 100 days of skilled nursing care.
The payment structure changes at day 20. On days 1 through 20, Medicare pays the full cost and you pay nothing. Starting on day 21, you pay a daily copay — the amount changes each year, but in 2024 it is $200 per day. After day 100, Medicare pays nothing and you are responsible for the full bill, which typically runs $300 to $500 per day depending on your location and the facility.
If you are discharged and then readmitted to a hospital within 60 days of leaving the nursing home, you are still in the same benefit period. If you are readmitted after 60 days have passed, a new benefit period begins and you get another 100 days of coverage. However, if you have used all 100 days in your current benefit period and are still in the nursing home, you will have to pay out of pocket until a new benefit period starts.
What Counts as Skilled Nursing Care
Medicare distinguishes between skilled care and custodial care, and this distinction determines whether it will pay. Skilled care is medical treatment that requires the training and judgment of a licensed nurse or therapist. Examples include changing sterile wound dressings, managing a catheter, administering intravenous medications, physical therapy to regain strength after a hip fracture, or speech therapy after a stroke.
Custodial care is help with activities of daily living — bathing, dressing, grooming, toileting, eating, and moving around. Even if a nurse provides this help, Medicare does not cover it because it does not require skilled medical judgment. A person with advanced dementia who needs 24-hour supervision and help with all personal care is receiving custodial care, not skilled care, and Medicare will not pay for a nursing home stay for that reason alone.
The distinction matters because your doctor and the nursing home must document that you need skilled care and that your condition is improving or stabilizing as a result of that care. If the nursing home's notes show that you are only receiving help with daily living, Medicare can deny payment retroactively, leaving you with a large bill. Ask your discharge planner to explain in writing which services Medicare will cover in your case.
The Three-Day Hospital Stay Requirement
You must have been admitted to a hospital as an inpatient for at least three consecutive days before Medicare will cover a nursing home stay. The key word is admitted — observation stays do not count, even if you spend three days in the hospital. An observation stay is outpatient care, and Medicare treats it differently for billing purposes.
This rule catches many people off guard. You might spend three days in the hospital being observed, tests run, and medications adjusted, but if your doctor never formally admitted you as an inpatient, Medicare will not cover the nursing home. Before you are discharged, ask your nurse or doctor directly: "Am I admitted as an inpatient, or am I on observation status?" If you are on observation, ask whether the hospital can change your status before discharge, because this affects your nursing home coverage.
If you are discharged to a nursing home and later discover you were on observation status, you may be able to appeal. Contact Medicare at 1-800-MEDICARE and ask about a Quality Improvement Organization (QIO) review. The QIO can review whether your hospital stay should have been inpatient rather than observation, though this process takes time and is not may provide to succeed.
What Happens When Medicare Coverage Ends
When you reach day 100 of your nursing home stay or when Medicare determines you no longer need skilled care, Medicare stops paying. At that point, you have several options depending on your financial situation and your state's rules.
If you have long-term care insurance, your policy may cover nursing home costs. Check your policy documents or call your insurance company to find out what it covers and what you need to do to file a claim. If you do not have long-term care insurance, you can pay out of pocket if you have the resources, or you can look into Medicaid, which is a joint federal-state program that covers nursing home 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 in some states) and a monthly income below a certain threshold. Some people spend down their savings to become Medicaid-may be able to access, though you should speak with an elder law attorney before doing this because there are rules about how quickly you can transfer assets.
If you cannot pay and do not may have access to for Medicaid, talk to the nursing home's social worker or financial counselor about payment plans or whether the facility has funds to help residents in your situation. Some nursing homes are nonprofit and have charitable care programs.
How to Prepare Before Leaving the Hospital
Before you are discharged from the hospital, your discharge planner should help you understand what Medicare will and will not cover. Ask these specific questions:
- Am I being admitted to the hospital as an inpatient, or am I on observation status?
- How many days have I been an inpatient so far?
- Does my condition require skilled nursing care, or only custodial care?
- Which nursing homes in the area accept Medicare for my type of care?
- How many days of Medicare coverage do you expect I will need?
- What will I owe out of pocket after day 20?
- What happens if I need to stay longer than 100 days?
Ask the discharge planner to put the answers in writing, including the name of the nursing home you are being sent to and the expected length of stay. If you disagree with the plan or do not feel ready to leave, you can ask to speak with the hospital's patient advocate or ombudsman.
If you are being discharged to a nursing home and you are concerned about whether Medicare will cover it, you can also call Medicare directly at 1-800-MEDICARE before you leave the hospital and ask them to review your situation. They can tell you whether your hospital stay meets the three-day requirement and whether your condition is likely to may have access to for skilled nursing coverage.
Medicare Advantage and Nursing Home Coverage
If you have a Medicare Advantage plan (Part C) instead of Original Medicare, the rules for nursing home coverage are the same — you still need a three-day inpatient hospital stay, and you still get up to 100 days of coverage. However, your copays and the nursing homes in your plan's network may be different. Some Medicare Advantage plans have higher copays for nursing home care or a smaller network of facilities that accept the plan.
Before you need a nursing home, check your Medicare Advantage plan documents or call the plan to find out which nursing homes are in-network and what your copay will be on days 21 through 100. If you are already in a nursing home and you have a Medicare Advantage plan, make sure the facility is in-network, because out-of-network care may cost you more or may not be covered at all.
Frequently Asked Questions
Does Medicare cover nursing home care if I did not spend three days in the hospital?
No. Medicare requires a three-day inpatient hospital stay before it will cover nursing home care. An observation stay does not count. If you go directly from home or an outpatient procedure to a nursing home, Medicare will not pay for it. You would need to pay out of pocket or use Medicaid if you may have access to.
What if I need to stay in the nursing home longer than 100 days?
After 100 days in a benefit period, Medicare stops paying and you are responsible for the full cost. If you may have access to for Medicaid based on your income and assets, Medicaid may take over payment. Otherwise, you must pay out of pocket, use long-term care insurance if you have it, or work with the nursing home on a payment plan.
Can Medicare cover a nursing home stay for dementia or Alzheimer's disease?
Only if the person also needs skilled nursing care — such as wound care, medication management, or therapy — in addition to help with daily living. Dementia alone does not may have access to because it requires custodial care, not skilled care. If the person has both dementia and a recent injury or illness requiring skilled care, Medicare may cover the nursing home stay temporarily.
Will Medicare cover the cost of my room and board in the nursing home?
No. Medicare covers only the cost of skilled nursing care and related services. You are responsible for room and board, which is included in the daily nursing home rate. This is one reason why many people need Medicaid or long-term care insurance to cover nursing home costs long-term.
What should I do if Medicare denies coverage for my nursing home stay?
You have the right to appeal. You will receive a notice explaining why Medicare denied coverage. You can request a reconsideration, and if you disagree with that decision, you can ask for a Quality Improvement Organization (QIO) review. Call 1-800-MEDICARE to start the appeal process, or ask the nursing home's social worker for help.