Medicare covers skilled nursing care, but only under specific conditions

Medicare Part A covers a stay in a skilled nursing facility (SNF) — a facility that provides medical care beyond what you can get at home — but the coverage has strict rules. You must be admitted to the facility within one day of a hospital stay of at least three days, and a doctor must order the care for a condition related to your hospital stay. Medicare will not cover a nursing home stay if you are admitted directly from home, even if you need skilled care.

The facility itself must be Medicare-certified. Most nursing homes are, but not all. Before you or a family member is discharged from the hospital, ask the discharge planner whether the facility accepts Medicare and whether your specific stay will be covered.

Key Takeaways

  • Medicare Part A 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 1–20, a daily copay of $194.50 (in 2024) for days 21–100, and all costs after day 100.
  • The facility must be Medicare-certified and the care must be for a condition related to your hospital stay, not a new problem.
  • If you need ongoing care after Medicare coverage ends, you will need to pay out of pocket, use Medicaid if you may have access to, or explore long-term care insurance.

How long Medicare pays and what you pay out of pocket

Medicare Part A covers up to 100 days per benefit period (a benefit period begins when you enter the hospital and ends 60 days after you leave the hospital or nursing facility, whichever is later). You pay nothing for the first 20 days. From day 21 through day 100, you pay a daily copay. That copay amount changes each year; in 2024 it is $194.50 per day. After day 100, Medicare pays nothing and you pay the full cost of the facility.

The 100-day limit resets only when a new benefit period begins. If you are discharged and readmitted to a hospital within 60 days, you are still in the same benefit period, and your remaining skilled nursing days do not increase. If you are discharged and stay out of the hospital for 60 days or more, a new benefit period begins and you get another 100 days of coverage.

Many people do not use all 100 days. If you improve and no longer need skilled care — for example, you can manage your medications and physical therapy on your own at home — Medicare stops paying, even if days remain in your benefit period.

What counts as skilled nursing care

Medicare only covers care that requires the skills of a nurse or therapist. This includes wound care, injections, physical therapy, occupational therapy, speech therapy, and monitoring of complex medical conditions. It does not include help with bathing, dressing, eating, or toileting unless those tasks are part of a therapy program.

The difference matters because many nursing homes provide both skilled care and custodial care. If you need only custodial care — help with daily living — Medicare will not pay, even if you are in a Medicare-certified facility. A nurse or therapist must assess you regularly to determine whether you still need skilled care. If the facility decides you no longer do, they must notify you and Medicare, and your coverage ends.

The three-day hospital stay requirement

To may have access to for Medicare coverage of skilled nursing, you must have been admitted to a hospital (not an emergency room or observation status) and stayed for at least three consecutive days. The three days must be full calendar days — the day you are admitted does not count, but the day you are discharged does. You must then be admitted to the skilled nursing facility within one day of hospital discharge.

This rule trips up many people because "observation status" in a hospital does not count toward the three days, even if you are in a hospital bed. If your hospital stay was observation only, you do not may have access to for Medicare-covered skilled nursing care. Ask the hospital before discharge whether you were admitted as an inpatient or kept on observation status. If you were on observation status and need skilled care, you will have to pay out of pocket or use another source of coverage.

What happens when Medicare coverage ends

When your 100 days are up or when Medicare decides you no longer need skilled care, the facility must give you written notice at least two days before coverage stops. At that point, you have three options: pay the facility's daily rate out of pocket, move to a less intensive setting (such as assisted living or home care), or explore whether you may have access to for Medicaid coverage.

Medicaid is a joint federal and state program that covers long-term care for people with limited income and assets. Each state sets its own rules, but generally you must have less than $2,000 in countable assets (rules vary by state). If you may have access to, Medicaid can cover a nursing home stay indefinitely, though you may have to spend down your savings first. Contact your state Medicaid office or a social worker at the facility to learn whether you might may have access to.

Some people have long-term care insurance, which pays for nursing home or home care after a waiting period. If you have this policy, notify the insurance company before Medicare coverage ends so they can begin paying their share.

How to confirm coverage before admission

Before you or a family member is discharged from the hospital to a skilled nursing facility, ask the hospital discharge planner these questions: Is the facility Medicare-certified? Will my specific stay be covered by Medicare? How many days of coverage do I have left in my benefit period? What will I owe out of pocket?

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to confirm coverage, though the hospital discharge planner usually has this information. Get the answers in writing if possible. If the facility is not Medicare-certified or your stay will not be covered, ask the discharge planner to help you find a facility that will accept Medicare.

Frequently Asked Questions

Can Medicare cover skilled nursing if I go straight from home to a nursing home?

No. Medicare only covers skilled nursing after a hospital stay of at least three days. If you need care at home, Medicare Part B covers some home health services, but a nursing home stay without a prior hospital stay is not covered by Medicare.

What if I run out of days before I am ready to leave?

Once your 100 days are used or Medicare stops paying, you must pay the facility's full daily rate out of pocket unless you may have access to for Medicaid or have long-term care insurance. Talk to the facility's social worker about payment plans or Medicaid options before your coverage ends.

Do I have to use a Medicare-certified facility?

Yes, if you want Medicare to pay. Non-certified facilities will not accept Medicare payment. Your hospital discharge planner can help you find a certified facility that has an available bed and accepts your insurance.

If I leave the nursing home and come back, do I get more days?

Only if 60 days have passed since you left the hospital or nursing facility. If you are readmitted within 60 days, you are still in the same benefit period and your remaining days do not increase. After 60 days, a new benefit period begins and you get another 100 days.

What if the facility says I no longer need skilled care but I disagree?

You have the right to appeal. The facility must give you written notice at least two days before coverage stops. You can request a detailed explanation of why they believe you no longer need skilled care and file an appeal with Medicare. Contact 1-800-MEDICARE for help with the appeal process.