Medicare covers some nursing home costs, but only under specific conditions and for a limited time

Medicare will pay for a nursing home stay, but not the way many people think. It does not cover custodial care — help with daily living like bathing, dressing, or meals — which is what most long-term nursing home residents need. Medicare only pays for skilled nursing care, which means medical treatment that requires a nurse or therapist: wound care after surgery, physical therapy, intravenous medications, or monitoring after a hospital stay. Even then, Medicare pays only for the first 100 days, with your costs rising sharply after day 20.

The distinction matters because it determines whether Medicare will pay anything at all. If you enter a nursing home for rehabilitation after a hip fracture — to regain strength and learn to walk again — Medicare may cover most of the cost for up to 100 days. If you enter because you can no longer live alone and need daily help, Medicare will not pay, and you will need to cover the cost yourself, through Medicaid, or through long-term care insurance if you have it.

Key Takeaways

  • Medicare pays for skilled nursing care in a nursing home only after a hospital stay of at least three consecutive days, and only if you are admitted within 30 days of leaving the hospital.
  • Medicare covers the full cost of days 1 through 20, but you pay a daily coinsurance amount (currently $194.50 per day in 2024) for days 21 through 100.
  • After day 100, Medicare stops paying entirely, and you must pay out of pocket or turn to Medicaid if you meet its income and asset limits.
  • Medicaid, not Medicare, is the primary payer for long-term custodial nursing home care, but you must spend down your savings to become may be able to access in most states.
  • You should ask your hospital discharge planner which nursing home accepts Medicare and confirm the facility will accept your insurance before you are discharged.

The three-day hospital stay requirement

Medicare will only pay for a nursing home stay if you spent at least three consecutive days in a hospital when ready before admission. The three days must be for inpatient care — not observation, which is a different billing category that does not count. Many people admitted to a hospital for observation instead of inpatient status do not realize this until they are discharged and told Medicare will not cover their nursing home care.

You must also be admitted to the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home weeks later, the hospital stay no longer counts, and Medicare will not pay. The nursing home must also be certified by Medicare and must accept Medicare patients. Not all nursing homes do, so it is important to confirm this before you are discharged from the hospital.

How much Medicare pays and for how long

Medicare covers the full cost of skilled nursing care for the first 20 days with no out-of-pocket cost to you. Starting on day 21, you pay a daily coinsurance amount — currently $194.50 per day in 2024, though this amount changes each year. You pay this amount for days 21 through 100. After day 100, Medicare stops paying entirely, and you are responsible for the full cost of care.

The 100-day limit resets only if you have a break of at least 60 consecutive days without receiving skilled nursing care. If you leave the nursing home for a few days and return, the clock does not reset. Many people assume they can return to the nursing home after a brief hospital stay and get another 100 days of coverage, but this is not how the benefit works — the days you already used count against your total.

What Medicare does not cover in a nursing home

Medicare does not pay for custodial care, which is the primary reason most people live in nursing homes long-term. Custodial care includes help with bathing, dressing, toileting, eating, and moving around — the activities of daily living. It also does not cover room and board, medications you take at home (though medications given as part of your skilled care are covered), or personal care items like toiletries or clothing.

If you need only custodial care and no skilled nursing services, Medicare will not pay anything, even if you are in a nursing home. You will need to pay privately, turn to Medicaid if you meet its limits, or rely on family support. Some people mistakenly believe that Medicare will eventually cover a nursing home stay if they stay long enough — it will not. The benefit is designed for short-term rehabilitation, not long-term residence.

Medicaid as the long-term payer

Medicaid, not Medicare, is the program that pays for long-term nursing home care for most people who cannot afford it. Medicaid is a joint federal and state program, and each state sets its own income and asset limits. In most states, you must have less than $2,000 in countable assets (the limit varies by state) to become may be able to access for Medicaid nursing home coverage.

Before Medicaid will pay, you must spend down your savings to reach the asset limit — a process called "spend-down." Some expenses count toward spend-down, such as medical bills and nursing home costs you pay yourself, while others do not. The rules are complex and vary by state. If you think you may need long-term nursing home care, it is worth speaking with an elder law attorney or a Medicaid planner before you enter a facility, because some planning strategies can protect assets while still allowing you to become Medicaid-may be able to access.

What to do before entering a nursing home

Before you are discharged from the hospital, ask your discharge planner which nursing homes accept Medicare and are located near your home or family. Ask the nursing home directly whether they accept Medicare patients and whether they have an available bed. Some facilities have long waiting lists or do not accept Medicare at all.

Request a written estimate of what you will owe out of pocket, including the daily coinsurance for days 21 through 100 if your stay extends that long. Ask whether the facility will bill Medicare directly or whether you will need to pay and seek reimbursement. Confirm that the facility is Medicare-certified by checking the Medicare Care Compare tool on Medicare.gov, which lists all certified facilities in your area and shows their inspection records and staffing levels.

If you think your stay may extend beyond 100 days, ask the nursing home's social worker about Medicaid planning and whether the facility accepts Medicaid. Some nursing homes do not accept Medicaid patients, which means you would need to transfer to a different facility when Medicare stops paying — an important detail to know before you arrive.

Understanding your bill and appealing denials

When you receive a bill from the nursing home, it should show what Medicare paid and what you owe. If Medicare denies coverage entirely — for example, because it determined the care was custodial rather than skilled — you have the right to appeal. The nursing home or your doctor can request a review, or you can request one yourself by calling 1-800-MEDICARE.

If you disagree with a coverage decision, you can ask for a detailed explanation of why Medicare denied the claim. Sometimes the issue is that the nursing home did not document the skilled care properly, and a resubmission with better documentation can reverse the denial. If the denial stands and you believe it is wrong, you can pursue a formal appeal, though this process takes time and may require legal help.

Frequently Asked Questions

Does Medicare cover nursing home care if I did not spend three days in the hospital?

No. Medicare requires a three-day inpatient hospital stay when ready before nursing home admission. Observation stays do not count. If you were in observation, Medicare will not pay for the nursing home, and you will need to pay privately or turn to Medicaid.

What happens to my Medicare coverage after day 100?

Medicare stops paying entirely after day 100. You are responsible for the full cost of care. If you meet Medicaid's income and asset limits, you may become Medicaid-may be able to access at that point, but you must first spend down your savings to the state's limit.

Can I use a Medigap or Medicare Advantage plan to cover nursing home costs?

Some Medigap plans cover the daily coinsurance for days 21 through 100, but they do not extend Medicare's 100-day limit or cover custodial care. Medicare Advantage plans follow the same rules as Original Medicare for nursing home coverage. Check your plan documents or call your plan to see what nursing home costs are covered.

If I leave the nursing home and return later, do I get another 100 days?

Only if you have a break of at least 60 consecutive days without receiving skilled nursing care. If you return within 60 days, the days you already used count against your 100-day limit. Most people do not get a second 100-day benefit.

How do I know if a nursing home is Medicare-certified?

Check the Medicare Care Compare tool at Medicare.gov, which lists all Medicare-certified nursing homes by location. You can also call the nursing home directly and ask whether they are Medicare-certified. The facility should be able to tell you when ready.