Medicare covers some nursing home costs, but not all of them, and only under specific conditions
Medicare will pay for a limited stay in a skilled nursing facility (a nursing home that provides medical care), but only if you meet strict requirements. You must have been in a hospital for at least three consecutive days, be admitted to the nursing home within 30 days of leaving the hospital, and need daily skilled nursing or rehabilitation services — not just help with daily living. Medicare pays the full cost for days 1 through 20, then you pay a daily copay for days 21 through 100. After day 100 in the same benefit period, Medicare stops paying and you pay everything yourself.
If you need a nursing home but do not meet these conditions — for example, you go directly from home without a hospital stay, or you need custodial care rather than skilled care — Medicare does not cover it. Many people assume Medicare will pay for long-term nursing home care, and then face a shock when they learn it will not.
Key Takeaways
- Medicare covers up to 100 days in a skilled nursing facility per benefit period, but only after a may have access to hospital stay of at least three days.
- You pay nothing for days 1 through 20, then a copay (currently $194.50 per day in 2024, though this amount changes yearly) for days 21 through 100.
- Medicare does not cover custodial care — help with bathing, dressing, meals, and toileting — which is what many nursing home residents actually need.
- Medicaid, not Medicare, is the program that covers long-term nursing home stays for people who meet income and asset limits.
- Long-term care insurance, personal savings, and family support are the main ways people pay for nursing home care beyond what Medicare covers.
What "Skilled Nursing Facility" means and why it matters
A skilled nursing facility is a nursing home where a nurse or therapist provides medical care or rehabilitation under a doctor's orders. This includes wound care, physical therapy after surgery, intravenous medications, or monitoring of a complex medical condition. The key word is skilled — the care must require a trained medical professional, not just a nursing aide.
Many nursing homes are licensed as skilled nursing facilities, but that does not mean everyone living there receives skilled care. Some residents need only custodial care — help with bathing, dressing, meals, and toileting. Medicare will not pay for custodial care, even if you live in a skilled nursing facility. The facility will bill Medicare for the skilled portion of your care and bill you or another payer for the custodial portion.
The three-day hospital stay requirement and the 30-day window
To may have access to for Medicare coverage of a nursing home stay, you must have been admitted to a hospital and stayed for at least three consecutive days. The three days must be for inpatient care, not observation. This distinction matters: some hospitals admit patients under "observation status" rather than "inpatient status," and observation days do not count toward the three-day requirement.
You must enter the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home weeks later, you do not may have access to for Medicare coverage of that stay, even if you were recently hospitalized. The 30-day clock starts the day you leave the hospital.
If you are unsure whether your hospital stay was inpatient or observation, ask the hospital billing department or your discharge paperwork. This is one of the most common reasons people think Medicare will cover a nursing home stay when it will not.
How much Medicare pays and what you pay
Medicare covers 100 percent of the cost for the first 20 days. For days 21 through 100, you pay a daily copay. In 2024, that copay is $194.50 per day, but the amount changes each year. After day 100 in the same benefit period, Medicare pays nothing and you are responsible for the full cost.
The benefit period runs from October 1 to September 30 each year. If you use all 100 days in one stay, you cannot get another 100 days of Medicare coverage until the next benefit period begins. Some people use part of their 100 days, recover, and then need the nursing home again later in the same year — in that case, they have fewer days remaining.
The daily copay covers the room, meals, nursing care, and other routine services. It does not cover private duty nursing, certain medications, or equipment not provided by the facility. Check with the nursing home about what is and is not included in the copay.
When Medicare coverage ends and what happens next
Medicare stops paying after 100 days in the same benefit period, or sooner if your doctor determines you no longer need skilled care. The nursing home must notify you in writing before they discharge you or before Medicare coverage ends. You have the right to appeal if you disagree with the decision.
When Medicare coverage ends, you have several options. You can pay out of pocket if you have savings. You can explore for Medicaid if your income and assets fall within your state's limits — Medicaid covers long-term nursing home stays, unlike Medicare. You can look into long-term care insurance if you have a policy. Or you can leave the nursing home and arrange care at home or with family.
Some people move to a different level of care, such as an assisted living facility or adult day care, which may be covered by other insurance or paid privately. Talk to the nursing home social worker about your options before your Medicare coverage ends.
Medicaid coverage for long-term nursing home stays
If you need a nursing home for months or years, Medicaid — not Medicare — is the program that covers it. Medicaid is a joint federal and state program for people with low income and limited assets. Each state sets its own income and asset limits, so what qualifies in one state may not in another.
To explore for Medicaid, contact your state Medicaid office or your local social services department. The nursing home social worker can often help you start the process. Medicaid covers the full cost of nursing home care once you are approved, though you may be required to contribute some of your income toward the cost.
Medicaid has strict rules about assets. If you own a home, a car, and savings above the limit, you may need to spend down those assets before Medicaid will pay. Some people work with an elder law attorney to plan ahead and protect assets while still becoming Medicaid-may be able to access. This is a complex area, and professional guidance can save money and time.
Other ways people pay for nursing home care
Long-term care insurance is a private insurance policy that covers nursing home costs, assisted living, and in-home care. If you bought a policy before entering a nursing home, it may cover some or all of the cost. Check your policy documents or call your insurance company to see what is covered and what you need to do to file a claim.
Personal savings and family support are how many people cover the gap between what Medicare pays and the full cost of care. The average cost of a semi-private room in a nursing home varies widely by region — from under $7,000 per month in some areas to over $15,000 in others. If you have savings, you may be able to pay out of pocket for a limited time.
Some nursing homes offer financial information or sliding scale fees for people who cannot pay the full cost. Ask the admissions office whether they have programs available. Some also accept Medicaid, which means they will work with you to become Medicaid-may be able to access if you are not already.
Questions to ask your doctor and the nursing home
Before you enter a nursing home, ask your doctor whether the care you need qualifies as skilled care under Medicare rules. Ask whether your hospital stay was inpatient or observation status. Ask the nursing home whether they are a Medicare-certified skilled nursing facility and what portion of your care will be billed to Medicare versus billed to you.
Ask the nursing home for an estimate of your out-of-pocket costs for the first 20 days (when Medicare covers everything) and for days 21 through 100 (when you pay the copay). Ask what happens on day 101 and whether they accept Medicaid. Ask whether there are any costs not covered by the daily copay, such as medications or therapy.
Get the answers in writing. Nursing home admissions staff can make mistakes or give incomplete information, and having written confirmation protects you if there is a dispute later about what you were told.
Frequently Asked Questions
Does Medicare cover nursing home care if I did not have a hospital stay first?
No. Medicare covers a nursing home stay only if you were hospitalized for at least three consecutive days as an inpatient and entered the nursing home within 30 days of discharge. If you go directly from home to a nursing home, Medicare will not pay for it, even if you need skilled care.
What is the difference between Medicare and Medicaid for nursing home costs?
Medicare covers up to 100 days of skilled nursing care after a hospital stay. Medicaid covers long-term nursing home stays for people with low income and limited assets, with no day limit. Medicaid is the program that pays for most long-term nursing home residents in the United States.
Can I appeal if Medicare stops paying before I am ready to leave?
Yes. You have the right to appeal if you disagree with the decision to end Medicare coverage. The nursing home must give you written notice before coverage ends. You can request a detailed explanation of why Medicare determined you no longer need skilled care, and you can ask for a review by an independent reviewer.
Will Medicare pay if I need a nursing home for physical therapy after surgery?
Yes, if you meet the requirements: a hospital stay of at least three consecutive days, admission to the nursing home within 30 days, and a need for skilled rehabilitation. Physical therapy after surgery typically qualifies as skilled care. Medicare will cover up to 100 days in the same benefit period.
What happens to my Medicare coverage if I run out of money to pay the copay on days 21 through 100?
Medicare continues to pay its share regardless of whether you can pay the copay. However, the nursing home can pursue collection efforts against you for the copay you owe. If you cannot pay, talk to the nursing home social worker about payment plans, financial information programs, or whether you might may have access to for Medicaid.