Medicare covers skilled nursing care, but only under specific conditions and for a limited time
Medicare Part A pays for skilled nursing home care after a hospital stay, but the coverage has strict rules. You must have been admitted to a hospital for at least three consecutive days, move to a skilled nursing facility within 30 days of leaving the hospital, and need daily skilled care — not just help with daily living. Medicare will pay for up to 100 days per benefit period, though you pay nothing for days 1–20 and a daily copay for days 21–100. After day 100, you pay the full cost yourself.
The key word is skilled. This means medical or rehabilitation care that requires a nurse or therapist — wound care, physical therapy, medication management, or monitoring after surgery. Help with bathing, dressing, or meals alone does not count as skilled care, even if you need it.
Key Takeaways
- Medicare Part A covers skilled nursing care only after a may have access to hospital stay of at least three consecutive days.
- You must enter the skilled nursing facility within 30 days of hospital discharge for Medicare to pay.
- Medicare covers up to 100 days per benefit period, with no cost for days 1–20 and a daily copay for days 21–100.
- The facility must be Medicare-certified, and your doctor must order the skilled care as medically necessary.
- Custodial care — help with daily activities without skilled medical or therapy needs — is never covered by Medicare.
What counts as a may have access to hospital stay
The hospital admission must be for at least three consecutive calendar days. Observation stays do not count — you must be formally admitted as an inpatient. The three days include the day you are admitted and the day you are discharged, so a Friday admission through Monday discharge counts as three days.
After discharge, you have 30 days to enter a Medicare-certified skilled nursing facility. If you wait longer than 30 days, Medicare will not pay, even if you later need skilled care. Some facilities will still admit you, but you will pay out of pocket or use another insurance source.
How many days Medicare will pay for
Each benefit period allows up to 100 days of skilled nursing care. A benefit period starts the day you enter the hospital and ends 60 days after you leave the skilled nursing facility. If you need skilled care again after that 60-day window closes, a new benefit period begins, and you get another 100 days.
Your costs change based on how long you stay. Days 1–20 cost you nothing — Medicare Part A covers 100 percent. Days 21–100 require a daily copay, which changes each year; in 2024 it is $194 per day. After day 100, you pay the full daily rate of the facility, which varies widely by location and facility type.
What types of care Medicare covers in a skilled nursing facility
Medicare pays for skilled nursing care delivered by a registered nurse or licensed practical nurse, such as wound dressing changes, catheter care, intravenous therapy, or medication administration that requires monitoring. It also covers skilled rehabilitation services — physical therapy, occupational therapy, or speech therapy — when ordered by your doctor and medically necessary for your recovery.
Routine services like meals, laundry, activities, and transportation within the facility are included in the daily rate. Room and board are covered. Medications you take during your stay are covered. However, any care that is not skilled — such as information with bathing or dressing when you do not need skilled supervision — is not a covered service, even if the facility provides it.
When Medicare coverage ends
Medicare stops paying when one of three things happens: you reach day 100 of your benefit period, your doctor determines you no longer need daily skilled care, or the facility determines you are not making progress toward recovery and discharges you. The facility must notify you in writing if they believe you no longer need skilled care, and you have the right to appeal that decision.
If you are discharged before day 100 but still need care, you may transition to custodial care at the same facility or elsewhere, but Medicare will not pay for it. Some people use long-term care insurance, Medicaid, or personal funds to cover custodial care after Medicare ends.
The difference between Medicare and Medicaid coverage
Medicare covers skilled nursing care for a limited time after a hospital stay. Medicaid, a separate program for people with lower income and assets, can cover both skilled and custodial nursing home care for longer periods or indefinitely, depending on your state and circumstances. Some people have both Medicare and Medicaid; Medicaid can cover costs Medicare does not, such as the daily copay or care after day 100.
If you think you might need long-term nursing home care beyond what Medicare covers, ask the facility's social worker about Medicaid planning. Medicaid rules are complex and vary by state, but planning early can protect your assets.
How to confirm a facility accepts Medicare
Not all nursing homes are Medicare-certified. Before you or your hospital discharge planner chooses a facility, confirm it is certified to accept Medicare. You can search for Medicare-certified facilities on Medicare.gov using their Nursing Home Compare tool, which also shows inspection results, staffing levels, and quality measures.
When you are discharged from the hospital, the discharge planner will usually help you find a Medicare-certified facility. If you have a preference, tell them early. Some facilities have waiting lists, and your insurance coverage window is limited, so speed matters.
Frequently Asked Questions
What happens if I leave the skilled nursing facility before day 100?
If you are discharged because you no longer need skilled care, Medicare stops paying. If you leave on your own, Medicare coverage ends the day you leave. You remain responsible for any costs after that date. If you later need skilled care again, you would need a new hospital stay to restart Medicare coverage.
Can Medicare pay for a nursing home stay without a hospital stay first?
No. Medicare Part A skilled nursing care requires a prior hospital admission of at least three consecutive days. If you need nursing home care but have not been hospitalized, Medicare will not pay. You would need to use Medicaid, long-term care insurance, or personal funds.
Do I have to use the facility my hospital recommends?
No. The hospital discharge planner will suggest facilities, but you can choose any Medicare-certified skilled nursing facility you prefer, as long as you enter within 30 days of discharge. If your choice has no beds available, you may need to go elsewhere temporarily and transfer later.
What if the facility says I am not making progress and wants to discharge me?
The facility must notify you in writing and explain why they believe you no longer need skilled care. You have the right to appeal this decision. Contact your state's long-term care ombudsman or ask the facility's social worker about the appeal process. You can also call Medicare at 1-800-MEDICARE for guidance.
Will Medicare pay for my spouse to stay in the same room?
No. Medicare covers only the patient's skilled nursing care. If your spouse needs a room, that is a separate arrangement and cost between you and the facility. Some facilities offer private rooms or semi-private rooms; costs vary.