Medicare covers some nursing home costs for dementia, but only under specific conditions — and only for a limited time
Medicare will pay for a skilled nursing facility (a nursing home with medical staff on site) if you are admitted directly from a hospital stay of at least three days, and if a doctor says you need daily skilled care — such as wound care, physical therapy, or medication management — related to the condition that sent you to the hospital. Dementia alone does not may have access to. But if you were hospitalized for pneumonia, a fall, or another acute illness, and you need skilled care to recover, Medicare may cover the nursing home stay.
The coverage is temporary. Medicare pays for up to 100 days in a benefit period (which resets each year). You pay nothing for the first 20 days. Days 21 through 100, you pay a daily coinsurance amount — in 2024, that is $200 per day, though this figure changes yearly. After 100 days, you pay the full cost yourself.
If you need a nursing home purely for dementia care — meaning you do not need skilled medical care — Medicare does not pay. Custodial care, which is help with daily tasks like bathing, dressing, and eating, is not covered by Medicare. In that case, you would need to pay out of pocket, use Medicaid (which does cover custodial care in nursing homes), or explore other options.
Key Takeaways
- Medicare covers nursing home stays only if you were hospitalized for at least three days first and need skilled medical care — not custodial care for dementia alone.
- Coverage lasts up to 100 days per benefit period, with you paying nothing for days 1–20 and a daily coinsurance amount for days 21–100.
- If you need a nursing home only for dementia care without skilled medical needs, Medicare does not pay, but Medicaid may if you meet income and asset limits.
- A doctor must order the nursing home stay and document that skilled care is medically necessary for your recovery.
- The nursing home must be Medicare-certified and you must be admitted within 30 days of leaving the hospital.
When Medicare Will and Will Not Pay
Medicare distinguishes between skilled care and custodial care. Skilled care is medical or therapeutic work that requires a nurse, therapist, or other licensed professional — wound dressing, medication injection, physical therapy, speech therapy, or monitoring of a serious condition. Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, and supervision.
If you have dementia and need only supervision and help with daily tasks, that is custodial care, and Medicare will not pay for it in a nursing home. If you have dementia and were hospitalized for a stroke, and you now need physical therapy and nursing care to regain function, that is skilled care, and Medicare may cover the nursing home stay that follows.
The hospital stay must be at least three consecutive days (not counting the day you are discharged). You must be admitted to the nursing home within 30 days of leaving the hospital. The nursing home must be Medicare-certified. And a doctor must document in writing that skilled care is medically necessary.
How Long Medicare Pays and What You Pay
Medicare's nursing home benefit runs on a benefit period basis. A benefit period begins the day you are admitted to the hospital and ends 60 days after you leave the hospital or nursing home, whichever is later. Once a benefit period ends, a new one begins if you are hospitalized again.
Within each benefit period, Medicare covers up to 100 days of nursing home care. Here is how the cost breaks down:
| Days | What You Pay | What Medicare Pays |
|---|---|---|
| 1–20 | $0 | 100% of approved charges |
| 21–100 | Daily coinsurance (2024: $200/day) | The rest of approved charges |
| 101+ | 100% of all costs | $0 |
The daily coinsurance amount changes each year. Check your Medicare Summary Notice or call Medicare at 1-800-MEDICARE to confirm the current amount. If you have a Medigap or Medicare Advantage plan, it may cover some or all of your coinsurance — check your plan documents.
What Happens After Medicare Coverage Ends
Once you reach 100 days in a benefit period, or if you no longer need skilled care, Medicare stops paying. At that point, you have several options.
If you still need custodial care for dementia, you can pay out of pocket if you have the funds. Many families use savings, long-term care insurance, or help from relatives. If your income and assets are low enough, you may be able to switch to Medicaid, which does cover custodial nursing home care. Medicaid rules vary by state, but generally you must have limited income and assets. Some states allow you to keep a home and a car while may have access to for Medicaid.
You can also explore assisted living facilities, which are less expensive than nursing homes and may be covered by long-term care insurance or paid out of pocket. Some assisted living communities specialize in dementia care. Adult day programs, in-home care, or moving in with family are other options depending on the level of care needed and your resources.
How to Find Out What Medicare Will Cover for Your Situation
The only way to know whether Medicare will cover a specific nursing home stay is to have a conversation with the hospital discharge planner and the nursing home's admissions staff before you leave the hospital. Ask the discharge planner directly: "Will Medicare cover my stay in the nursing home?" They should be able to tell you whether the doctor has ordered skilled care and whether the nursing home is Medicare-certified.
You can also call Medicare at 1-800-MEDICARE and describe your situation. Have your hospital discharge papers and the name of the nursing home ready. Medicare staff can tell you whether the stay is likely to be covered based on the diagnosis and the type of care ordered.
Ask the nursing home's admissions staff to provide a written estimate of what Medicare will cover and what you will owe. This estimate should include the number of days Medicare is expected to cover and your daily coinsurance amount for days 21–100. Do not rely on a verbal answer — get it in writing so you have a record.
Medicaid as an Alternative if Medicare Does Not Pay
Medicaid is a joint federal-state program that covers nursing home care, including custodial care for dementia, if you meet income and asset limits. Unlike Medicare, Medicaid does not require a hospital stay first. You can enter a nursing home directly and use Medicaid from day one if you are financially may be able to access.
Medicaid income and asset limits vary by state. Some states are more generous than others. In most states, your monthly income must be below a certain threshold (often around $2,000 to $2,500 for an individual), and your countable assets must be below a limit (often around $2,000). Your home, one car, and some personal items do not count toward the asset limit.
If you have too much income or assets to may have access to for Medicaid now, you may be able to "spend down" — use your money for care, medical expenses, or other allowed purposes — until you meet the limits. Some people work with an elder law attorney to plan this legally. Once you may have access to, Medicaid pays the nursing home directly, though you may be required to contribute some of your income toward your care.
To explore Medicaid, contact your state's Medicaid office or a local Area Agency on Aging. You can find your local agency by calling the Eldercare Locator at 1-800-677-1116.
Common Mistakes to Avoid
Do not assume Medicare will pay just because you are in a nursing home. Medicare covers only skilled care following a hospital stay, not custodial dementia care. If the nursing home is providing only supervision and help with daily tasks, Medicare will not pay, even if you were recently hospitalized.
Do not wait until day 100 of your stay to ask what comes next. Start planning around day 80. Talk to the nursing home's social worker or discharge planner about your options: Medicaid, long-term care insurance, out-of-pocket payment, or discharge to another setting. Waiting until the last moment leaves you scrambling.
Do not assume the nursing home is Medicare-certified. Ask directly. A facility that looks professional may not be certified, and Medicare will not pay if it is not. The nursing home should be able to show you its Medicare certification.
Do not ignore your Medicare Summary Notice. After your stay, Medicare will send you a notice showing what it paid and what you owe. Review it carefully. If the dates or amounts look wrong, call Medicare to ask questions. Errors happen, and catching them early matters.
Frequently Asked Questions
If I have dementia and live in a nursing home now, can Medicare start paying retroactively?
No. Medicare covers only nursing home stays that follow a hospital stay of at least three days. If you are already in a nursing home and were not hospitalized first, Medicare will not pay, even if you explore now. Medicaid may cover you if you meet income and asset limits, regardless of how long you have been there.
What if I was hospitalized but discharged to home, and then admitted to a nursing home a month later?
Medicare will not pay. You must be admitted to the nursing home within 30 days of leaving the hospital. If you wait longer, the hospital stay no longer counts, and you lose the Medicare coverage. Plan the nursing home admission before you leave the hospital if you think you will need it.
Does Medicare Advantage cover nursing home care differently than Original Medicare?
Medicare Advantage plans must cover at least what Original Medicare covers for skilled nursing care. Some plans offer additional benefits, such as covering more days or waiving coinsurance. Check your plan's coverage documents or call the plan directly to see what it covers for your specific situation.
Can I use my long-term care insurance to pay for a nursing home if Medicare does not cover it?
Yes, if you have a long-term care insurance policy. Long-term care insurance is designed to cover custodial care in nursing homes, assisted living, and at home. Review your policy to see what it covers, what the daily benefit is, and whether there is a waiting period before benefits begin. Many policies cover dementia care.
What is the difference between a skilled nursing facility and a regular nursing home?
A skilled nursing facility has licensed nurses and therapists on staff and provides medical care. A regular nursing home may provide only custodial care. Medicare covers only stays in Medicare-certified skilled nursing facilities. Ask the facility whether it is certified for Medicare before you admit someone there.