Medicare covers some nursing home costs, but only under specific conditions and for a limited time
Medicare pays for skilled nursing care after a hospital stay, not for long-term residential care. If you go directly to a nursing home without being hospitalized first, Medicare will not pay. Even after hospitalization, Medicare covers only the first 100 days, and you pay nothing for days 1–20, then a daily copay for days 21–100. After day 100, you pay the full cost yourself unless you have a supplemental insurance policy or Medicaid.
The key word is skilled care — nursing and therapy services that require a licensed professional. If you need help with bathing, dressing, or meals but not skilled medical care, Medicare does not cover it, even in a nursing home. Many people assume "nursing home" automatically means Medicare coverage. It does not. The type of care you need determines whether Medicare pays.
Key Takeaways
- Medicare covers skilled nursing care only after a hospital stay of at least three days, and only for up to 100 days total.
- You pay nothing for days 1–20, then a copay (the amount varies yearly) for days 21–100, after which you pay all costs.
- If you enter a nursing home without a hospital stay first, Medicare does not pay anything, regardless of your medical needs.
- Medicaid, not Medicare, is the program that covers long-term nursing home care for people who meet income and asset limits.
- A Medigap supplemental insurance policy can cover some or all of the copays Medicare does not pay.
The three-day hospital stay requirement
Medicare's nursing home coverage begins only after you have been admitted to a hospital as an inpatient for at least three consecutive days. Observation stays do not count — you must be formally admitted as an inpatient. This is a common source of confusion because observation patients often spend nights in the hospital but are not technically admitted.
After you leave the hospital, you must enter the nursing home within 30 days for Medicare to cover it. The nursing home must also be Medicare-certified, which most are, but it is worth confirming when you are looking at facilities. If you go home first and then decide later that you need nursing home care, Medicare will not pay for it, even if your medical condition has not changed.
What Medicare pays for in a nursing home
Medicare covers the cost of a semi-private room (two beds), meals, nursing care, medications, medical equipment, and therapy services like physical therapy or occupational therapy. It does not cover a private room unless medically necessary, and it does not cover personal care attendants or help with activities of daily living unless those services are part of your skilled care plan.
The nursing home must provide care that requires the skills of a licensed nurse or therapist. Examples include wound care, intravenous therapy, catheter management, or physical therapy after surgery or stroke. If you are in the nursing home only because you cannot live alone or need help with daily tasks, Medicare does not cover it. Medicaid may, but that is a different program with different rules.
How much you pay out of pocket
For 2024, Medicare covers all costs for days 1–20 with no copay. For days 21–100, you pay a daily copay amount set by Medicare each year. The copay amount changes annually, so check with your nursing home or Medicare directly for the current figure. After day 100 in the same benefit period, you pay 100 percent of the cost.
A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home. If you return to the hospital and then to a nursing home again, a new benefit period starts, and your day count resets to 1. This means you could potentially have multiple covered stays in one year if you are hospitalized more than once.
Many people buy Medigap supplemental insurance specifically to cover the copays Medicare does not pay. Some Medigap plans cover the full copay for days 21–100, while others cover part of it. The cost and coverage of Medigap plans vary by insurance company and by state, so compare plans before you enroll.
When Medicaid takes over for long-term care
If you need to stay in a nursing home longer than 100 days, Medicaid — not Medicare — is the program that may pay. 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 be covered by Medicaid for nursing home care, you typically must have income below a certain level and assets below a certain limit. Some people "spend down" their savings to meet Medicaid's asset limit, though there are rules about how you can do this without penalty. Once you meet Medicaid's financial requirements, it covers the full cost of nursing home care with no daily limit.
Medicaid planning is complex and involves understanding your state's specific rules. Many nursing homes have a social worker or financial counselor who can explain Medicaid to you and help you understand whether you might be covered. Some people also work with an elder law attorney to plan ahead.
What happens when Medicare coverage ends
When you reach day 101 in the nursing home, Medicare stops paying. At that point, you have three main options: pay privately out of pocket, transition to Medicaid if you meet the financial requirements, or leave the nursing home and receive care at home or in another setting.
Many nursing homes will work with you to transition to Medicaid if you are close to meeting the asset limit. Some facilities also offer a private-pay rate that is lower than the Medicare rate, though this varies. It is important to have this conversation with the nursing home's business office before you reach day 100 so you understand your options and can plan ahead.
How to learn about a nursing home is Medicare-certified
You can search for Medicare-certified nursing homes on the Medicare.gov website under "Care Compare." This tool lets you search by location and see which facilities accept Medicare, what services they offer, and inspection results. Not all nursing homes are Medicare-certified, so if you want Medicare to pay, confirm the facility's status before you choose it.
If you are still in the hospital and need to move to a nursing home, the hospital's discharge planner can help you find a Medicare-certified facility and arrange the transfer. The discharge planner can also explain what Medicare will and will not cover in your specific situation. Do not hesitate to ask questions — this is part of their job.
Frequently Asked Questions
Can Medicare pay for a nursing home if I did not spend three days in the hospital?
No. Medicare requires a hospital stay of at least three consecutive days as an inpatient before it will cover nursing home care. Observation stays do not count. If you go directly to a nursing home or enter one after an observation stay, Medicare will not pay.
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 nursing home care for people with low income and limited assets, with no day limit. Most people who need nursing home care longer than 100 days rely on Medicaid, not Medicare.
If I have a Medigap policy, does it cover the nursing home copay?
Some Medigap plans cover part or all of the copay for days 21–100. Not all plans do, so check your policy documents or call your insurance company. If your plan does not cover it, you pay the copay yourself or use other resources like savings or family help.
What if I run out of money while I am in the nursing home?
If you have spent down your assets to meet Medicaid's limit, you can transition to Medicaid coverage. The nursing home's social worker or financial counselor can help you understand whether you may have access to and how the process works. Some states have specific rules about how quickly this transition can happen.
How do I know how many days I have left on my Medicare coverage?
The nursing home's billing department tracks your days and will tell you when you are approaching day 100. You can also call Medicare directly at 1-800-MEDICARE to ask about your remaining covered days. Keep track yourself as well so there are no surprises.