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 custodial care in a nursing home. The difference matters: skilled care means you need daily medical treatment or rehabilitation that only a nurse or therapist can provide. Custodial care — help with bathing, dressing, meals, and daily living — is not covered by Medicare, even if you live in a nursing home facility.
To get Medicare coverage, you must have been admitted to a hospital for at least three consecutive days (not counting the discharge day), then move directly to a Medicare-approved skilled nursing facility within 30 days. Medicare then covers up to 100 days per benefit period, but with cost-sharing that increases after day 20. After 100 days, you pay the full cost yourself.
Many people assume a nursing home stay is automatically covered because they have Medicare. It is not. The facility must be Medicare-approved, your doctor must order the care, and the care itself must be skilled — not just supervision or information with daily tasks.
Key Takeaways
- Medicare covers skilled nursing facility care for up to 100 days per benefit period only if you spent at least three consecutive days in a hospital first.
- You pay nothing for days 1–20, then $194.50 per day (in 2024) for days 21–100, after which Medicare coverage ends and you pay all costs.
- The facility must be Medicare-approved and your care must be skilled — physical therapy, wound care, or medical monitoring — not help with bathing or meals alone.
- If you need custodial care only, Medicare does not pay; Medicaid, long-term care insurance, or your own funds become the payment source.
The three-day hospital stay requirement
You must be admitted to a hospital as an inpatient for at least three consecutive calendar days before Medicare will cover a nursing home stay. The day you are discharged does not count toward the three days. If you are in the hospital for observation only — not admitted as an inpatient — those days do not count either, even if you spend 72 hours there.
This is a common trap. Many people spend three days in the hospital under "observation status" and assume they meet the requirement. They do not. Ask your hospital whether you are admitted as an inpatient or held for observation. If you are unsure, request the status in writing before discharge.
You must move to the nursing facility within 30 days of hospital discharge. If you go home first and then enter a nursing home weeks later, the hospital stay no longer counts, and Medicare will not pay.
How much Medicare pays and what you owe
Medicare covers the full cost of skilled nursing facility care for the first 20 days of each benefit period. Starting on day 21, you pay a daily coinsurance amount. In 2024, that amount is $194.50 per day, though this figure changes each year. After day 100, Medicare coverage stops entirely and you are responsible for all costs.
The 100-day limit resets when you begin a new benefit period. A benefit period starts the day you enter a hospital and ends 60 days after you leave the hospital or nursing facility, whichever is later. If you are readmitted to a hospital during that 60-day window, the clock does not reset — you are still in the same benefit period.
| Days in Facility | Your Cost | Medicare Pays |
|---|---|---|
| 1–20 | $0 | 100% of approved charges |
| 21–100 | $194.50/day (2024) | Remainder of approved charges |
| 101+ | 100% of all charges | $0 |
The coinsurance amount applies only to days you actually stay in the facility. If you are discharged on day 45, you owe coinsurance for days 21–45 only.
Skilled care versus custodial care
Medicare distinguishes between skilled care and custodial care. Skilled care requires the daily involvement of a nurse, therapist, or other licensed professional. Examples include wound dressing changes, intravenous medication, physical therapy after a hip fracture, speech therapy after a stroke, or monitoring of a new medication regimen.
Custodial care is help with activities of daily living: bathing, dressing, grooming, toileting, eating, and moving around. Even if a nursing home provides this care and a doctor orders it, Medicare does not pay if it is custodial only. Many people need both — skilled care for a few weeks and then custodial care for months or years. Medicare covers only the skilled portion.
The nursing home's care plan will specify what type of care you are receiving. If you disagree with the classification, you can request a review. Medicare's Quality Improvement Organization (QIO) can reconsider whether your care is truly custodial or whether it includes a skilled component.
What happens after Medicare coverage ends
When you reach day 101 or when Medicare determines your care is no longer skilled, Medicare stops paying. At that point, you must cover the cost yourself, or another payer must step in. Medicaid is the most common alternative — it covers custodial nursing home care for people who meet income and asset limits, which vary by state.
If you have long-term care insurance, check your policy to see whether it covers nursing home care and under what conditions. Some policies require a waiting period before they begin paying, or they may pay a fixed daily amount rather than the full cost.
Many people pay out of pocket for nursing home care after Medicare coverage ends. This is why planning ahead — through savings, insurance, or Medicaid planning — matters. Once you are in the facility and Medicare coverage is ending, your options narrow.
How to find a Medicare-approved facility
Not all nursing homes are Medicare-approved. Before you are discharged from the hospital, ask the discharge planner which facilities near you accept Medicare. You can also search the Medicare Care Compare tool on Medicare.gov, which lists all Medicare-approved facilities in your area and shows their inspection history and staffing levels.
The facility must be a skilled nursing facility (SNF), not just a nursing home. Some facilities are licensed only for custodial care and do not have the staffing or equipment to provide skilled care. Verify the facility's Medicare approval before you move there — if it is not approved, Medicare will not pay even if your care is skilled.
Your hospital discharge planner can help you find a facility, but you have the right to choose. Do not feel pressured to go to the first facility offered. Ask about the facility's experience with your condition, its staffing levels, and its discharge planning process.
Common mistakes to avoid
The most common mistake is assuming that any nursing home stay is covered. It is not. You must meet the three-day hospital admission requirement, and your care must be skilled. Many people enter a nursing home for custodial care only and discover too late that Medicare will not pay.
Another mistake is not understanding the 100-day limit. Some people believe Medicare covers nursing home care indefinitely as long as they are receiving skilled care. It does not. After 100 days in a benefit period, coverage ends, regardless of your medical needs.
A third mistake is not asking about your status during a hospital stay. If you are unsure whether you are admitted as an inpatient or held for observation, ask before discharge. This status directly affects whether Medicare will cover a subsequent nursing home stay.
Finally, do not wait until you are discharged to think about payment. If you will owe coinsurance or if coverage will end before you are ready to leave, start planning when ready. Talk to the facility's financial counselor about Medicaid, payment plans, or other options.
Frequently Asked Questions
Does Medicare cover assisted living facilities?
No. Medicare covers only skilled nursing facilities, not assisted living. Assisted living provides custodial care and supervision, which Medicare does not pay for. If you need skilled care, you must be in a skilled nursing facility. If you need only custodial care, Medicare does not cover it anywhere.
What if I need nursing home care but did not spend three days in a hospital?
Medicare will not pay. You will need to cover the cost yourself, or you may be able to use Medicaid if you meet your state's income and asset limits. Some people use long-term care insurance or savings. Talk to the facility's financial counselor about your options.
Can I choose which nursing home Medicare pays for?
Yes. You have the right to choose any Medicare-approved skilled nursing facility. Your hospital discharge planner can give you a list, but you are not required to go to any particular facility. Verify that the facility is Medicare-approved before you move there.
What happens if Medicare says my care is no longer skilled?
You can request a review through Medicare's Quality Improvement Organization. If you disagree with the decision, you have the right to appeal. During the appeal, you may owe the daily coinsurance amount, but you are not responsible for the full cost until the appeal is decided.
Does Medicare cover nursing home care after a fall or accident?
Only if you were hospitalized for at least three days first and the care you need is skilled — such as physical therapy or wound care. If you fall at home and go directly to a nursing home without a hospital stay, Medicare will not pay, even if you need rehabilitation.