Medicare covers some nursing home costs, but only under specific conditions and only for a limited time
Medicare pays for skilled nursing facility care — not all nursing home care, and not indefinitely. You must first spend at least three days in a hospital, then move directly to a Medicare-certified skilled nursing facility within 30 days. Medicare then covers up to 100 days per benefit period, but only if you need daily skilled nursing or rehabilitation services. If you need custodial care — help with bathing, dressing, or meals — Medicare does not pay, even in a nursing home.
The amount Medicare pays changes based on how long you stay. For days 1 through 20, Medicare covers the full cost. From day 21 onward, you pay a daily coinsurance amount (in 2024, this is $194.50 per day, though this figure changes yearly). After day 100, you pay all costs yourself. Many people run out of Medicare coverage before they leave the facility.
Key Takeaways
- Medicare covers skilled nursing facility stays only after a hospital stay of at least three days, and only if you move to the facility within 30 days of leaving the hospital.
- Medicare pays for up to 100 days per benefit period, with full coverage for the first 20 days and a daily coinsurance amount for days 21 through 100.
- Medicare does not cover custodial care — information with daily living activities — even if you receive it in a nursing home.
- Once your 100 days end or your medical need for skilled care stops, you must pay out of pocket, switch to Medicaid if you may have access to, or leave the facility.
The three-day hospital stay requirement
You must spend at least three consecutive days as an inpatient in a hospital before Medicare will pay for a skilled nursing facility. Observation stays do not count — only days when you are formally admitted as an inpatient. This distinction matters because many people spend time in the hospital under "observation" rather than as admitted patients, and they later discover they do not meet the requirement.
After you leave the hospital, you have 30 days to enter a Medicare-certified skilled nursing facility. If you wait longer than 30 days, you lose the connection to that hospital stay, and Medicare will not pay. You can ask the hospital discharge planner to help you find a facility and arrange the transfer quickly.
What "skilled nursing care" means to Medicare
Medicare distinguishes between skilled nursing care and custodial care. Skilled care includes wound care, physical therapy, occupational therapy, speech therapy, intravenous medication, catheter management, and other services that require a nurse or therapist. Custodial care includes bathing, dressing, toileting, eating, and other activities of daily living — even if a nurse provides them.
A doctor must order the skilled services, and a nurse or therapist must provide them. If you are in a nursing home only for custodial care — even if you are frail or have dementia — Medicare does not pay. The facility's care plan determines whether your stay qualifies. If your condition improves and you no longer need skilled services, Medicare stops paying even if you stay in the same facility.
How much Medicare pays and what you pay
| Days in facility | What Medicare pays | What you pay |
|---|---|---|
| Days 1–20 | 100% of approved costs | $0 |
| Days 21–100 | Approved costs minus daily coinsurance | Daily coinsurance amount (2024: $194.50) |
| Day 101 and beyond | $0 | 100% of all costs |
The daily coinsurance amount changes each year. You can find the current amount on Medicare.gov or by calling 1-800-MEDICARE. Some Medigap or Medicare Advantage plans cover part or all of the coinsurance, so check your plan documents.
Medicare's approved cost is not necessarily what the facility charges. The facility must accept Medicare's payment as payment in full for the covered portion. You cannot be billed for the difference between what Medicare approves and what the facility charges, but you are responsible for the coinsurance and any costs after day 100.
What happens when your 100 days end
Once you reach day 101, Medicare stops paying entirely. At that point, you have three main options: pay out of pocket, switch to Medicaid if you meet its income and asset limits, or leave the facility. Many people cannot afford to pay privately, so they look into Medicaid.
Medicaid covers long-term nursing home care, but the rules are different from Medicare. Medicaid is a joint federal and state program, so coverage varies by state. Most states require you to spend down your savings to a certain level before Medicaid pays. You should contact your state Medicaid office or a social worker at the nursing home to learn what Medicaid covers in your state and whether you might may have access to.
Medicare Advantage and Medigap coverage of nursing homes
If you have a Medicare Advantage plan, it must cover at least what Original Medicare covers for skilled nursing facilities. Some plans offer additional benefits, such as covering more than 100 days or waiving the coinsurance. Check your plan's summary of benefits or call the plan directly to learn what it covers.
If you have a Medigap policy, it may cover some or all of your coinsurance for days 21 through 100. Medigap plans vary, so review your policy or call your insurance company. Medigap does not extend coverage beyond day 100.
Questions to ask your doctor and the nursing home
Before you enter a nursing home, ask your doctor whether your condition requires skilled nursing care or only custodial care. Ask the nursing home whether it is Medicare-certified and whether your specific services are covered. Request a written estimate of how long Medicare is likely to pay based on your condition and the services you need.
Ask the facility's social worker or financial counselor what happens when your 100 days end and what your options are. Ask whether the facility accepts Medicaid, because if you will need to switch to Medicaid, you want to know whether you can stay in the same place. Get all cost information in writing before you sign any agreement.
Frequently Asked Questions
Does Medicare cover nursing home care if I did not have a hospital stay first?
No. Medicare covers skilled nursing facility care only after a hospital stay of at least three consecutive days as an inpatient. If you go directly to a nursing home from home or from an outpatient appointment, Medicare does not pay for the nursing home, even if you need skilled care.
If I need custodial care but not skilled care, what pays?
Medicare does not pay for custodial care under any circumstance. Medicaid may pay if you meet your state's income and asset limits. If you do not may have access to for Medicaid, you must pay out of pocket, use long-term care insurance if you have it, or explore other community resources.
Can I use my Medicare Advantage plan instead of Original Medicare for nursing home coverage?
Yes. Medicare Advantage plans must cover at least what Original Medicare covers for skilled nursing facilities. Some plans offer better coverage, such as more days or lower coinsurance. Review your plan's benefits or contact the plan to compare.
What if the nursing home says Medicare will not pay for my stay?
You have the right to appeal. Ask the facility to explain in writing why it believes Medicare will not pay. You can also contact Medicare at 1-800-MEDICARE or ask the facility's social worker to help you understand the decision. If you disagree, you can request a review.
Does Medicare cover nursing home care for rehabilitation after surgery?
Yes, if you meet the requirements: a hospital stay of at least three days, admission to a Medicare-certified skilled nursing facility within 30 days, and a medical need for skilled nursing or rehabilitation services. Physical therapy and occupational therapy after surgery are skilled services that Medicare covers.