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

Medicare will pay for a skilled nursing facility (SNF) stay after a hospital stay, but not for long-term custodial care. The difference matters: Medicare pays when you need medical care or rehabilitation — wound care, physical therapy, medication management — but stops paying when you need help with daily living because of chronic illness or disability. Many people assume Medicare covers nursing homes the way it covers hospitals. It does not.

After Medicare stops paying, you pay out of pocket until your money runs out, then Medicaid takes over if you meet its income and asset limits. Understanding when Medicare pays, how much you owe, and what happens next can prevent financial surprises and help you plan ahead.

Key Takeaways

  • Medicare covers skilled nursing facility care only after a hospital stay of at least three consecutive days, and only for up to 100 days per benefit period.
  • You pay nothing for days 1–20, then $200 per day (in 2024) for days 21–100, with Medicare covering the rest.
  • Medicare stops paying when you no longer need skilled care — when you are stable and need only help with bathing, dressing, and meals.
  • Long-term nursing home care is paid by you, your family, long-term care insurance, or Medicaid once your assets fall below your state's limit.
  • You must tell Medicare within 60 days if you disagree with the decision to stop payment, or you lose the right to challenge it.

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 first. The three days must be for the same condition or a related one — a three-day stay for a broken hip counts, but a three-day stay for pneumonia does not count if you are now in the nursing home for heart failure. Observation stays do not count; you must be admitted as an inpatient, not held for observation.

This rule trips up many people. You may feel you need nursing home care after a hospital visit, but if you were never formally admitted as an inpatient or if your stay was only two days, Medicare will not pay. Ask the hospital before discharge whether you were admitted as an inpatient and how many days that admission covers. If you are unsure, ask to speak with the hospital's patient advocate or billing department. Get the answer in writing so you have proof of your admission status.

How long Medicare pays and what you pay

Medicare covers up to 100 days in a skilled nursing facility per benefit period. A benefit period starts 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 within that 60-day window, the days do not reset — you continue counting from where you left off.

Your costs depend on how many days you stay. Days 1–20 are fully covered by Medicare; you pay nothing. For days 21–100, you pay a daily coinsurance amount set at $200 per day in 2024, adjusted yearly, while Medicare pays the rest. On day 101 and beyond, you pay the full cost and Medicare pays nothing. The daily coinsurance is separate from any copay your supplemental insurance or Medicare Advantage plan might cover, so check your plan documents or call your plan to see what they cover for days 21–100.

When Medicare stops paying: the skilled care standard

Medicare stops paying when you no longer need skilled care — medical or rehabilitation services that require a licensed nurse or therapist. Skilled care includes wound dressing changes, intravenous medication, physical therapy, occupational therapy, and speech therapy. Once you are medically stable and no longer improving with therapy, Medicare considers you ready to leave.

The nursing home, not Medicare, decides when you no longer need skilled care. They will notify you in writing that Medicare will stop paying on a specific date. This is where disputes often happen. You may feel you still need help, but if that help is custodial — bathing, dressing, toileting, eating — rather than skilled, Medicare will not pay. Custodial care is what long-term nursing homes provide, and it is not a Medicare benefit.

You have the right to disagree with this decision. You must tell Medicare within 60 days of receiving the notice, or you lose the right to challenge it. Contact your nursing home's patient advocate or call Medicare directly at 1-800-MEDICARE to request a review. Do not wait; the 60-day window is firm.

What happens when Medicare stops paying

When your 100 days end or when Medicare decides you no longer need skilled care, you become responsible for the full daily cost of the nursing home. Nursing home costs vary widely by state and facility — from roughly $100 to $300 per day for a semi-private room, more for a private room. At that rate, savings deplete quickly.

Once your assets fall below your state's Medicaid limit (usually $2,000 for an individual, though this varies), you may become may be able to access for Medicaid, which does cover long-term nursing home care. Medicaid is a joint federal-state program, so rules differ by state. Some states have a waiting list; others cover nursing home care when ready once you meet the asset and income limits. Contact your state Medicaid office or a local Area Agency on Aging to learn your state's rules and whether the nursing home you are in accepts Medicaid.

If you have long-term care insurance, check your policy now to see whether it covers nursing home care and under what conditions. Some policies require a hospital stay first; others do not. Knowing what your policy covers before you need it prevents surprises and helps you understand what you will owe when Medicare stops paying.

Questions to ask your doctor and the nursing home

Before you are discharged from the hospital to a nursing home, ask your doctor: "Will I need skilled nursing care, or will I need custodial care?" Ask the nursing home: "How long does Medicare typically pay for someone in my situation?" and "What happens when Medicare stops paying — what will my daily cost be?" These conversations help you understand what to expect financially and how long you may stay.

Ask the nursing home to explain in writing what skilled services you will receive and for how long they expect you to need them. Ask whether they will notify you before Medicare stops paying and what your options are at that point. Ask whether the facility accepts Medicaid, because if it does not, you will need to move when your money runs out. Get these answers in writing and keep them with your discharge papers.

If the nursing home tells you Medicare will stop paying on a specific date and you disagree, ask to speak with the facility's social worker or patient advocate. They can explain the clinical reason. If you still disagree, you have the right to request a review from Medicare within 60 days. Do not assume the decision is final.

The difference between Medicare and Medicaid in nursing homes

Medicare is federal health insurance for people 65 and older. It covers short-term skilled nursing care after a hospital stay. Medicaid is a joint federal-state program for people with low income and assets. It covers long-term nursing home care with no time limit, but only after you have spent down your savings to your state's asset limit.

Many people use both: Medicare pays for the first part of the stay, then Medicaid takes over when Medicare stops. Some nursing homes are certified for both; others accept only one. Before you choose a nursing home, confirm it accepts both Medicare and Medicaid if you think you may need Medicaid eventually. This prevents having to move mid-stay when your private funds run out.

Frequently Asked Questions

What if I need nursing home care but was never hospitalized?

Medicare will not pay. You will need to pay out of pocket, use long-term care insurance if you have it, or wait until you meet your state's Medicaid asset limits. Some people enter a nursing home as a private-pay resident and later switch to Medicaid once their savings are depleted.

Can I appeal if Medicare says I no longer need skilled care?

Yes. You have 60 days from the date you receive the notice to request a review. Contact Medicare at 1-800-MEDICARE or ask the nursing home's patient advocate to help you file. You must act within 60 days or you lose this right.

Does Medicare Advantage cover nursing home care differently?

Medicare Advantage plans must cover at least what Original Medicare covers — the same 100 days after a three-day hospital stay. Some plans cover additional days or waive the coinsurance. Check your plan's summary of benefits or call the plan directly to see what it covers.

What if the nursing home is not Medicare-certified?

Medicare will not pay. You must use a facility certified by Medicare to receive Medicare payment. Ask the nursing home whether it is Medicare-certified before you move in. The facility's administrator or admissions staff can tell you.

Do I need to pay the daily coinsurance upfront, or does the nursing home bill me?

The nursing home bills you for the coinsurance amount for days 21–100. You are responsible for paying it. Some facilities may ask you to sign a financial agreement before admission. Read it carefully and ask questions about what you will owe.