Medicare covers some nursing home costs, but only under specific conditions — and only for a limited time
Medicare pays for skilled nursing facility (SNF) care, which is nursing home care that includes medical treatment ordered by a doctor. It does not pay for custodial care — help with bathing, dressing, meals, and daily living — which is what most long-term nursing home residents need. The difference matters because it determines whether Medicare will pay anything at all.
Medicare will cover up to 100 days in a skilled nursing facility per benefit period, but you must meet strict conditions: you must have been in a hospital for at least three consecutive days first, you must enter the nursing home within 30 days of leaving the hospital, and a doctor must order the care as medically necessary. After day 20, you pay a daily copay. After day 100, you pay all costs yourself.
If you need ongoing help with daily activities but not skilled medical care, Medicare does not pay. Medicaid may, but Medicaid is a separate program with its own rules and income limits. Many people assume Medicare will cover a nursing home stay and discover too late that it will not.
Key Takeaways
- Medicare covers skilled nursing care ordered by a doctor after a hospital stay of at least three days, but only for up to 100 days per benefit period.
- You must enter the nursing home within 30 days of hospital discharge, and the facility must be Medicare-certified for the coverage to explore.
- After day 20, you pay a daily copay (the amount changes yearly); after day 100, Medicare pays nothing and you pay the full cost.
- If you need help with daily living but not skilled medical care, Medicare does not pay — Medicaid may cover this, but it has separate income and asset limits.
- Long-term nursing home care is usually not covered by Medicare and requires either private payment, Medicaid, or long-term care insurance.
What "Skilled Nursing Facility" means and why it matters
A skilled nursing facility is a nursing home that provides medical care under a doctor's orders. This includes wound care, physical therapy, medication management, or monitoring of a medical condition. It is not the same as a regular nursing home that provides custodial care only.
Medicare distinguishes between skilled care and custodial care. Skilled care requires a nurse or therapist to perform it. Custodial care is help with activities of daily living — bathing, dressing, eating, toileting — that a family member or aide could provide. If you need only custodial care, Medicare will not pay, even if you are in a nursing home.
The facility itself must be Medicare-certified. Not all nursing homes are. Before you or a family member is admitted, ask the nursing home whether it is Medicare-certified and whether the specific care ordered by the doctor qualifies as skilled care under Medicare rules. This is not a formality — it determines whether Medicare will pay.
The three conditions you must meet to get Medicare coverage
Medicare has three hard rules. You must meet all three or you pay the full cost.
First, a hospital stay of at least three consecutive days. This means three full calendar days and two midnights, not three calendar days that include a partial day. If you are admitted on a Monday and discharged on Wednesday, that counts. If you are admitted on Monday and discharged on Tuesday, it does not. Observation status — where the hospital is monitoring you but has not formally admitted you — does not count. Ask the hospital billing department whether you were admitted as an inpatient or placed on observation status.
Second, admission to the nursing home within 30 days of hospital discharge. If you go home first and then enter a nursing home two months later, Medicare will not pay. The 30-day clock starts the day you leave the hospital.
Third, a doctor's order for skilled nursing care. The care must be medically necessary and ordered by the hospital discharge planner or your doctor. You cannot choose to go to a nursing home for rehabilitation and expect Medicare to pay if no doctor has ordered skilled care.
How long Medicare pays and what you pay out of pocket
| Days in facility | What Medicare pays | What you pay |
|---|---|---|
| Days 1–20 | 100% of approved costs | Nothing (copay waived) |
| Days 21–100 | All costs minus your daily copay | Daily copay (amount set yearly by Medicare) |
| Day 101 and beyond | Nothing | 100% of all costs |
The daily copay for days 21–100 changes each year. In 2024, it is $194.50 per day, but confirm the current amount with the nursing home or Medicare before admission. The nursing home must tell you in writing what your copay will be.
After 100 days, Medicare coverage ends completely for that benefit period. A benefit period runs from January 1 to December 31 each year. If you are still in the nursing home on day 101, you pay the full daily rate out of pocket unless you have other insurance or are covered by Medicaid.
The nursing home must also be Medicare-approved and must bill Medicare directly. If the facility is not certified or does not bill Medicare, you will be billed for the full cost even if you meet all three conditions.
When Medicare coverage ends and what happens next
Medicare coverage ends when any of these happens: you have been in the facility for 100 days in the current benefit period, your doctor determines you no longer need skilled care, or you are discharged. If your doctor determines you no longer need skilled nursing care but you still need help with daily living, Medicare stops paying when ready.
When coverage ends, you have three options: pay privately, transition to Medicaid if you meet income and asset limits, or go home. Some people move to a different part of the nursing home that provides custodial care only and pay out of pocket. Others return home with home health services, which Medicare may cover if a doctor orders them.
Before you reach day 100, talk to the nursing home social worker about what comes next. They can tell you whether Medicaid coverage is an option and what the process process looks like. Do not wait until day 100 to plan.
Medicaid coverage for long-term nursing home care
Medicaid is a separate program from Medicare and covers long-term nursing home care, including custodial care. However, Medicaid has strict income and asset limits that vary by state. In most states, your monthly income must be below a certain threshold (often around $2,000 to $2,500 for a single person) and your assets must be below a limit (often around $2,000 to $3,000, not counting your home and car).
If you have too much income or assets, you may need to spend down — use your money to pay for care until you fall below the limit — before Medicaid will pay. Some people use a Medicaid planning attorney to structure their finances in a way that preserves assets for a spouse or family while meeting Medicaid limits, but this requires planning before you enter a nursing home.
Medicaid coverage is not automatic. You must explore through your state's Medicaid office, and the process can take weeks or months. Start the conversation with the nursing home social worker early, even while Medicare is still paying.
Long-term care insurance and private payment
If you do not have Medicaid coverage and Medicare has run out, you pay the full cost of nursing home care out of pocket. The average cost of nursing home care varies widely by location and level of care, but it is substantial — often $5,000 to $10,000 or more per month depending on where you live and what care you need.
Some people have long-term care insurance, which is a separate policy designed to cover nursing home costs. If you have this insurance, check your policy to see what it covers, what the daily or monthly benefit is, and whether there are waiting periods before coverage begins. Long-term care insurance is not common, but if you have it, now is the time to notify the insurer.
If you have neither Medicare coverage, Medicaid coverage, nor long-term care insurance, you will need to pay privately. This is why planning ahead matters — if you know a nursing home stay is likely, discussing these options with a financial advisor or elder law attorney before you need care can help you understand what resources you have.
Frequently Asked Questions
Does Medicare pay for nursing home care if I did not have a hospital stay first?
No. Medicare requires a hospital stay of at least three consecutive days before it will pay for skilled nursing facility care. If you go directly to a nursing home from home or from a doctor's office, Medicare will not pay, even if you need skilled care. You would need to pay privately or use Medicaid if you meet the income and asset limits.
What if I need nursing home care after day 100 — can I get another 100 days next year?
Yes, but only if you meet the conditions again: a new hospital stay of at least three days, admission to the nursing home within 30 days, and a doctor's order for skilled care. A new benefit period starts January 1 each year. If you are still in the nursing home on day 101 of the current year, you pay out of pocket until the new benefit period begins, unless Medicaid covers you.
Can I use Medicare to pay for help at home instead of a nursing home?
Yes, if a doctor orders home health care. Medicare covers skilled nursing visits, physical therapy, and occupational therapy at home, but not custodial care like housekeeping or meal preparation. Home health care must be ordered by a doctor and provided by a Medicare-certified agency. Ask your doctor whether home health is an option before entering a nursing home.
What is the difference between Medicare and Medicaid for nursing home care?
Medicare is federal health insurance for people 65 and older (and some younger people with disabilities). It covers skilled nursing facility care for up to 100 days after a hospital stay. Medicaid is a joint federal-state program for low-income people. It covers long-term nursing home care with no time limit, but you must meet income and asset limits. Many people use Medicare first, then transition to Medicaid when Medicare runs out.
Should I hire an elder law attorney to help with nursing home planning?
An elder law attorney can help you understand your options, plan for Medicaid coverage, and structure your finances to protect assets. This is most useful if you have significant assets, own property, or want to plan before a crisis forces a nursing home stay. If you have limited assets and expect to need Medicaid, the nursing home social worker can often guide you through the process at no cost.