Medicare covers some nursing home costs, but only under specific conditions and for a limited time
Medicare pays for skilled nursing care in a nursing home, but not for custodial care or long-term residence. The difference matters: skilled nursing care means you need daily medical treatment or rehabilitation that only a nurse or therapist can provide — wound care, physical therapy after surgery, medication management. Custodial care means help with daily activities like bathing, dressing, or eating, which Medicare does not cover.
Medicare will only pay if you meet three conditions at the same time: you spent at least three consecutive days in a hospital right before the nursing home stay, you enter the nursing home within 30 days of leaving the hospital, and a doctor orders the skilled nursing care as part of your treatment plan. If you go directly to a nursing home without a hospital stay, or if more than 30 days pass between hospital discharge and nursing home admission, Medicare will not pay.
Even when all three conditions are met, Medicare's payment is temporary. It covers up to 100 days per benefit period, but your out-of-pocket costs rise as you stay longer. Understanding these limits helps you plan for what comes next.
Key Takeaways
- Medicare covers skilled nursing care in a nursing home only if you had a hospital stay of at least three days and enter the nursing home within 30 days of discharge.
- Medicare pays the full cost for days 1 through 20, but you pay a daily coinsurance amount for days 21 through 100.
- After 100 days in a benefit period, Medicare stops paying and you become responsible for all costs.
- Custodial care — help with bathing, dressing, and eating — is never covered by Medicare, even in a nursing home.
- If you need long-term nursing home care, Medicaid, private pay, or long-term care insurance may cover costs that Medicare does not.
How Medicare's three-day hospital stay rule works
The hospital stay must be for acute care — treatment of a sudden illness or injury — and must last at least three consecutive days. Observation stays do not count, even if you are in the hospital building. An observation stay means the hospital is watching you to decide whether to admit you; an inpatient admission means the hospital has formally admitted you as an inpatient. Ask the hospital staff directly whether you are an inpatient or in observation, because the difference determines whether Medicare will later pay for nursing home care.
The 30-day window starts the day you leave the hospital. If you are discharged on a Monday, you must enter the nursing home by the following Sunday to stay within the window. If you go home first, receive outpatient therapy, or spend time in another facility, the clock keeps running. Once 30 days have passed, Medicare will not pay for the nursing home stay, even if you eventually need skilled care.
What Medicare pays and what you pay
For days 1 through 20 of your nursing home stay, Medicare covers the full cost of skilled nursing care. You pay nothing for the care itself, though you may still owe your Part B deductible if you have not met it yet during that benefit period.
For days 21 through 100, you pay a daily coinsurance amount. This amount changes each year; it is set at 25 percent of the hospital inpatient deductible. In 2024, that coinsurance is $200 per day, but confirm the current amount with Medicare or your nursing home's billing department. Medicare pays the rest.
After day 100 in a benefit period, Medicare stops paying entirely. You then pay the full daily cost of the nursing home out of pocket. A new benefit period begins on January 1 each year, so if your stay extends into the next calendar year, you may have access to another 100 days of coverage — but only if you meet the three-day hospital stay requirement again.
The difference between skilled nursing and custodial care
Skilled nursing care is treatment that requires a licensed nurse or therapist. Examples include wound dressing changes, intravenous medication, physical therapy, occupational therapy, and speech therapy. If you need these services daily or several times a week as part of your recovery, Medicare may cover the nursing home stay.
Custodial care is help with activities of daily living: bathing, dressing, grooming, toileting, eating, and moving around. Many nursing home residents need custodial care, and it is often the main reason people live in nursing homes long-term. Medicare does not cover custodial care under any circumstances, even if a nurse provides it. If custodial care is your primary need, you will pay out of pocket, through Medicaid (if you meet income and asset limits), or through long-term care insurance.
A nursing home may provide both types of care. Medicare covers the skilled portion; you pay for the custodial portion. Your nursing home bill will usually separate these costs so you can see what Medicare covers and what you owe.
What happens when Medicare coverage ends
When you reach day 100 or when your doctor determines you no longer need skilled care, Medicare stops paying. The nursing home must notify you in writing before this happens, usually at least two days in advance. At that point, you have three options: pay privately for continued nursing home care, move to a less expensive setting like assisted living or your home with home care services, or explore whether you meet the income and asset limits for Medicaid coverage.
Some people transition from Medicare-covered skilled nursing to Medicaid-covered long-term care in the same facility. Medicaid covers custodial care and long-term residence, but may be able to access depends on your income and assets. Each state sets its own limits, so contact your state Medicaid office or a local Area Agency on Aging to learn what applies where you live.
Planning for costs beyond Medicare coverage
The average cost of nursing home care varies widely by location and level of care, ranging from less than $100 per day in some rural areas to $300 or more per day in urban areas. Since Medicare covers at most 100 days and only if you meet strict conditions, most people who need long-term nursing home care will pay a significant portion themselves.
If you think you may need nursing home care in the future, consider long-term care insurance, which covers custodial care and extended stays. Policies vary widely in cost and coverage, so compare options while you are still in good health — insurers often deny coverage or charge higher premiums if you have existing health conditions. If you cannot afford or obtain long-term care insurance, talk with a financial advisor or elder law attorney about other planning strategies, such as setting aside savings or understanding Medicaid's rules about assets.
Frequently Asked Questions
Does Medicare cover a nursing home stay if I did not spend three days in the hospital?
No. If you go directly to a nursing home from home, an outpatient clinic, or an emergency room observation stay, Medicare will not pay for the nursing home, even if you need skilled care. You must have been admitted as an inpatient to a hospital for at least three consecutive days.
Can I use Medicare to pay for a nursing home if I need help with bathing and dressing but not medical care?
No. Help with bathing, dressing, and other daily activities is custodial care, which Medicare does not cover. If that is your only need, you would pay privately, use Medicaid if you meet income limits, or explore assisted living or home care as alternatives.
What if I stay in the nursing home longer than 100 days?
Medicare stops paying after 100 days in a benefit period. You then pay the full daily cost out of pocket unless you may have access to for Medicaid or have long-term care insurance. A new benefit period begins January 1, but you would need another three-day hospital stay to restart Medicare coverage.
Does my Medigap or Medicare Advantage plan cover what Medicare does not?
Some Medigap plans cover part of the daily coinsurance for days 21 through 100, but none cover custodial care or stays beyond 100 days. Medicare Advantage plans vary; check your plan documents or call the plan to see what nursing home costs it covers beyond original Medicare.
How do I know if my nursing home stay qualifies for Medicare coverage?
Ask your hospital discharge planner before you leave the hospital whether your stay qualifies. They can confirm you were admitted as an inpatient for three days and help arrange the nursing home referral within 30 days. Once admitted to the nursing home, ask the billing department to confirm Medicare is paying and for how long.