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 room, board, or custodial care that makes up most of the bill. Instead, Medicare covers skilled nursing care — medical treatment like wound care, physical therapy, or medication management — for up to 100 days after a hospital stay. Once those 100 days end, you pay the full cost yourself unless you have a supplemental insurance policy or your state's Medicaid program steps in.

The key difference is between skilled care (what Medicare covers) and custodial care (what it does not). Skilled care requires a nurse or therapist to perform the work. Custodial care is help with daily living — bathing, dressing, eating, toileting — that a family member could provide. If a nursing home is primarily providing custodial care, Medicare will not pay, even if a doctor ordered the placement.

Key Takeaways

  • Medicare covers skilled nursing care for up to 100 days only after a hospital stay of at least three consecutive nights.
  • You pay nothing for days 1–20, then $194.50 per day (in 2024) for days 21–100, and the full cost after day 100.
  • The nursing home must be Medicare-certified, and a doctor must order the stay as medically necessary.
  • Medicaid, not Medicare, covers long-term custodial nursing home care for people with limited income and assets.
  • Many people use a combination of Medicare (short-term), private pay (middle period), and Medicaid (long-term) to cover a full nursing home stay.

When Medicare will and will not pay

Medicare pays only when three conditions are met. First, you must have spent at least three consecutive nights in a hospital when ready before the nursing home stay — an observation stay does not count. Second, a doctor must order the nursing home care as medically necessary within 30 days of hospital discharge. Third, the care must be skilled nursing care — treatment that requires a licensed nurse or therapist, not just supervision or help with daily tasks.

Common skilled services Medicare covers include wound dressing changes, intravenous therapy, catheter care, physical therapy, occupational therapy, and speech therapy. If you are in a nursing home only because you cannot bathe or dress yourself, or because you need someone to remind you to take medication, Medicare will not pay. The nursing home must document in your medical record that skilled care is the reason for your stay, and that documentation must match what Medicare's reviewers see when they audit the claim.

Medicare does not cover custodial care under any circumstances, even if you are in a nursing home. It also does not cover room and board, meals, laundry, or activities — the facility charges you for those separately. If you stay beyond 100 days, Medicare stops paying entirely, and you become responsible for the full daily rate.

How much you pay out of pocket

Your costs depend on which days of your stay you are in. Days 1 through 20 are fully covered by Medicare — you pay nothing except your regular Part B premium. Starting on day 21, you pay a coinsurance amount for each day. In 2024, that amount is $194.50 per day, though it changes yearly. You pay this coinsurance for days 21 through 100. After day 100, Medicare pays nothing and you pay the full daily rate charged by the facility.

The daily rate at a nursing home varies widely by location and facility type. In some areas, skilled nursing care costs $300 to $400 per day; in others, it exceeds $500. Your coinsurance ($194.50 in 2024) covers part of that cost, but you are responsible for the difference. If the facility charges $400 per day and your coinsurance is $194.50, you pay $205.50 out of pocket for that day.

These costs reset each year. If you leave the nursing home and return to the hospital for three or more nights, then go back to a nursing home, you get a new 100-day benefit period. However, if you straightforward move to a different nursing home without a hospital stay in between, you do not reset the clock — you continue counting from where you left off.

The three-night hospital stay requirement

Many people lose Medicare coverage because they do not meet the three-night requirement. A hospital observation stay — where you are in a hospital bed but not formally admitted — does not count. You must be an inpatient, which means the hospital has admitted you to its inpatient census. Ask the hospital directly whether you are an inpatient or an observation patient; the distinction is not always clear from the room you are in.

If you are discharged after two nights and sent to a nursing home, Medicare will not pay for the nursing home stay. You will have to pay out of pocket or use Medicaid if you are already enrolled. Some people spend a third night in the hospital specifically to trigger the Medicare nursing home benefit, though this is a decision to make with your doctor based on your medical needs, not just to unlock coverage.

The three nights must be consecutive. If you are admitted, discharged, and readmitted within a short period, only the final admission counts toward the three-night requirement. The clock starts over with each new hospital admission.

Medicare-certified facilities and how to check

Medicare will only pay at a nursing home that is Medicare-certified. Not all nursing homes are certified. Before you are discharged from the hospital, ask the discharge planner whether the facility you are considering accepts Medicare. The facility itself can tell you, or you can search the Medicare Care Compare tool at Medicare.gov, which lists every certified nursing home in the country and shows which services each one provides.

A facility can be certified for skilled nursing care but not for other services. For example, a home might be certified for skilled nursing but not for rehabilitation therapy. If you need physical therapy and the facility is not certified to provide it, Medicare will not pay for your stay even if you meet all other requirements. The certification status can also change — a facility can lose its certification if it fails inspections or does not meet staffing standards.

When you are in the hospital, the discharge planner should help you find a Medicare-certified facility with an available bed. If you choose a non-certified facility, you will pay the full cost yourself. Some people do this intentionally because a particular facility is closer to family or has a better reputation, but you should know upfront that Medicare will not reimburse you.

What happens after Medicare stops paying

On day 101, Medicare's responsibility ends. At that point, you have four main options: pay out of pocket, use a supplemental insurance policy (sometimes called Medigap), use Medicaid, or leave the facility.

If you have a Medigap policy, check your policy documents to see whether it covers nursing home coinsurance and what it covers after day 100. Some Medigap plans cover the coinsurance for days 21–100, which saves you money during the Medicare period. Few cover costs after day 100, but some do.

Medicaid covers long-term nursing home care for people with limited income and assets, but the income and asset limits vary by state. In most states, you must have less than $2,000 in countable assets (though the exact number varies). If you are approaching day 100 and do not have savings to cover the cost, contact your state Medicaid office or a local Area Agency on Aging to learn whether you may be able to transition to Medicaid coverage. The process takes time, so start early — ideally before day 100 arrives.

How to prepare before a hospital stay

If you know you may need a nursing home stay, gather information before you enter the hospital. Make a list of Medicare-certified facilities near your home or family. Ask your doctor which facility would be appropriate for your condition. If you have a Medigap or Medicare Advantage plan, review what it covers for nursing home care.

When you are admitted to the hospital, tell the discharge planner when ready that you want to go to a specific facility if possible. Discharge planners work with many facilities and can often arrange placement, but they need to know your preference early. Ask the planner to confirm that the facility is Medicare-certified and that Medicare will pay for your stay based on your diagnosis and expected length of stay.

Before you are discharged, ask for a written summary of your hospital stay — the diagnosis, the procedures performed, and the reason skilled nursing care is medically necessary. Bring this to the nursing home. It helps the nursing home document your care correctly and reduces the chance that Medicare will deny the claim later.

Frequently Asked Questions

Will Medicare pay if I go to a nursing home without a hospital stay first?

No. Medicare only covers nursing home care that follows a hospital stay of at least three consecutive nights as an inpatient. If you go directly from home to a nursing home, Medicare will not pay. You would need to pay out of pocket or use Medicaid if you are enrolled.

What is the difference between Medicare and Medicaid for nursing homes?

Medicare covers skilled nursing care for up to 100 days after a hospital stay. Medicaid covers long-term custodial care for people with low income and assets. Most people use Medicare first (short-term), then transition to Medicaid (long-term) if they run out of savings. Medicaid rules vary by state.

Can I use Medicare Advantage instead of Original Medicare for nursing home coverage?

Yes. Medicare Advantage plans must cover the same skilled nursing care that Original Medicare covers. However, some Advantage plans have network restrictions — they may only pay at certain facilities. Check your plan documents or call the plan before you choose a nursing home.

What if the nursing home says Medicare will not pay for my stay?

Ask the facility to explain in writing why they believe Medicare will not pay. If you disagree, you can request a review from Medicare. Contact your hospital's discharge planner or call Medicare at 1-800-MEDICARE to ask about the appeal process.

Do I have to pay the coinsurance amount for days 21–100, or can Medicare cover it?

You are responsible for the coinsurance unless you have a Medigap policy that covers it. Original Medicare does not cover the coinsurance — you must pay it yourself or have supplemental coverage. Some Medigap plans cover this cost; check your policy.