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 or rehabilitation. It does not pay for custodial care, which is help with daily living like bathing, dressing, and meals. The difference matters because most people in nursing homes need custodial care, not skilled care, so Medicare does not cover their stay.

To get Medicare to pay, you must have been in a hospital for at least three consecutive days (not counting the day you leave), then move directly to a Medicare-approved nursing home within 30 days. You also must need daily skilled nursing or rehabilitation services related to the condition you were hospitalized for. If you move to a nursing home for any other reason — because you are frail, or because you live alone, or because you need help with daily tasks — Medicare will not pay.

Key Takeaways

  • Medicare covers skilled nursing care only after a hospital stay of at least three consecutive days, and only if you move to the nursing home within 30 days of leaving the hospital.
  • Medicare pays the full cost of the first 20 days in a Medicare-approved nursing home, then requires you to pay a daily copay (which varies yearly) for days 21 through 100.
  • After 100 days in the same nursing home for the same condition, Medicare stops paying entirely, and you must cover all costs yourself or use other insurance.
  • Custodial care — help with bathing, dressing, meals, and toileting — is never covered by Medicare, even if you are in a nursing home.
  • Many people use Medicaid, long-term care insurance, or personal savings to cover the costs Medicare does not pay or after Medicare coverage ends.

How long Medicare pays and what you pay out of pocket

Medicare covers up to 100 days of skilled nursing care in a benefit period. The payment structure has three tiers. For days 1 through 20, Medicare pays 100 percent of the cost, and you pay nothing. For days 21 through 100, Medicare pays most of the cost, but you pay a daily copay. That copay amount changes each year — it is set by Medicare and is the same no matter which nursing home you use.

After day 100 in the same nursing home for the same condition, Medicare stops paying. You then pay the full daily rate yourself, or you must have another form of insurance (such as Medicaid or a long-term care insurance policy) to cover the cost. If you leave the nursing home and return to the hospital for at least three days, a new benefit period can begin, and you may be covered for another 100 days — but this is a separate stay, not a continuation.

The daily copay for days 21 through 100 is substantial. Because it changes yearly, you should contact your nursing home or Medicare directly to learn the current amount before you need care. Many people are surprised to learn they must pay this copay themselves; Medicare does not cover it, and most supplemental insurance policies (Medigap) do not cover it either.

What "skilled nursing care" actually means

Skilled nursing care is medical or therapeutic treatment that must be given by a nurse or under a nurse's supervision. Examples include wound care after surgery, intravenous (IV) medications, physical therapy, occupational therapy, or speech therapy. If you need these services and are recovering from a hospitalization, Medicare may cover your stay.

Custodial care is not skilled care. It includes bathing, dressing, grooming, toileting, eating, and moving around — the daily living tasks that many older adults need help with. A nursing home can provide custodial care, but Medicare will not pay for it. If custodial care is the only service you need, you must pay out of pocket, use Medicaid (if you meet income and asset limits), or use a long-term care insurance policy.

Some people need both. For example, you might need physical therapy (skilled) and also need help bathing (custodial). Medicare will cover the skilled part of your stay, but you will still pay the daily copay for days 21 through 100, and you will pay for the custodial services yourself or through another insurance source.

The three-day hospital stay requirement

You must spend at least three consecutive days in a hospital before Medicare will pay for a nursing home stay. The rule is strict: the day you are admitted counts, but the day you are discharged does not. So if you enter the hospital on Monday and leave on Thursday, that is three days (Monday, Tuesday, Wednesday). If you leave on Wednesday, that is only two days, and Medicare will not cover nursing home care.

Observation status complicates this. Some hospitals place patients in "observation" rather than admitting them as inpatients. Observation days do not count toward the three-day requirement, even if you are in the hospital bed and receiving hospital care. If you are unsure whether you were admitted as an inpatient or placed in observation, ask the hospital billing department or your discharge planner before you leave.

You must also move to the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home two months later, Medicare will not pay, because you did not move directly from the hospital.

When Medicare stops paying and what happens next

Medicare coverage ends after 100 days in the same nursing home for the same condition. If you need to stay longer, you have several options. Medicaid is the most common source of payment for long-term nursing home care. Medicaid is a joint federal and state program for people with low income and limited assets. Each state sets its own rules, but generally you must have less than $2,000 in countable assets (the limit varies by state). If you have a long-term care insurance policy, it may cover costs after Medicare ends. If you have neither, you must pay the daily rate yourself, which can range from several thousand to over ten thousand dollars per month depending on the nursing home and your location.

Some people plan ahead by purchasing long-term care insurance while they are still healthy and working. Others spend down their savings to become may be able to access for Medicaid. Some rely on family members to help pay. There is no single right answer, but understanding what Medicare does and does not cover helps you plan with your family and financial advisor.

How to know if a nursing home accepts Medicare

Not all nursing homes accept Medicare. Before you move to a nursing home, confirm that it is Medicare-approved and that it will accept your Medicare coverage. You can search for Medicare-approved nursing homes on the Medicare.gov website under "Care Compare" or by calling 1-800-MEDICARE. Your hospital discharge planner can also help you find a facility that accepts Medicare.

When you contact a nursing home, ask directly: "Do you accept Medicare for skilled nursing care?" and "What is your current daily rate for days 21 through 100?" Some nursing homes may tell you they accept Medicare but then charge you additional fees on top of what Medicare pays. Ask about all costs upfront so there are no surprises.

Medicare Part A versus Part B in a nursing home

Medicare Part A is the part that covers nursing home care. Part A is hospital insurance, and it includes coverage for inpatient hospital stays, skilled nursing facility care, and some home health care. You do not need to do anything special to use Part A coverage for a nursing home — it is automatic if you meet the requirements (the three-day hospital stay, the direct transfer, and the need for skilled care).

Medicare Part B (medical insurance) may also cover some services while you are in the nursing home, such as doctor visits or certain therapies, but Part B does not cover the room and board or the basic nursing care. Part A is what pays for the nursing home stay itself.

Frequently Asked Questions

Can Medicare pay for a nursing home if I did not have a hospital stay?

No. Medicare requires a hospital stay of at least three consecutive days before it will cover nursing home care. If you move to a nursing home directly from home or from another setting, Medicare will not pay, even if you need skilled care. You would need to use Medicaid, long-term care insurance, or personal funds.

What if I need to stay in the nursing home longer than 100 days?

After 100 days, Medicare stops paying. You then must cover the cost yourself, use Medicaid (if you meet the income and asset limits), or use a long-term care insurance policy. Many people transition to Medicaid at this point. Contact the nursing home's social worker or financial counselor to learn about your options.

Does Medicare pay for memory care or assisted living?

Medicare does not cover assisted living facilities or memory care units. These are custodial care settings, not skilled nursing facilities. Medicare only covers skilled nursing facilities (nursing homes) when you meet the hospital stay requirement and need skilled care. Medicaid may cover some assisted living in certain states, but rules vary widely.

Will my Medigap or supplemental insurance cover the nursing home copay?

Most Medigap policies do not cover the daily copay for days 21 through 100 of nursing home care. Check your policy documents or call your insurance company to confirm. Some people purchase long-term care insurance specifically to cover these costs, but Medigap typically does not.

How do I know if I was admitted to the hospital or placed in observation?

Ask your hospital's billing department or discharge planner before you leave. Observation status does not count toward the three-day requirement. If you are unsure and later need nursing home care, call Medicare at 1-800-MEDICARE and provide your hospital admission date and discharge date — they can tell you whether you meet the requirement.