Medicare covers skilled nursing care for up to 100 days per benefit period, but only after a hospital stay and only for specific types of care

Medicare Part A pays for nursing home stays, but with strict limits. You must have been admitted to a hospital for at least three consecutive days (not counting the day you leave), and you must move to the nursing home within 30 days of leaving the hospital. Medicare then covers up to 100 days in a skilled nursing facility — a facility certified to provide skilled nursing or rehabilitation services. This is not the same as a regular nursing home or assisted living.

The coverage is not free for all 100 days. You pay nothing for days 1 through 20. From day 21 through day 100, you pay a daily coinsurance amount, which changes each year. In 2024, that amount is $200 per day. After day 100, Medicare stops paying and you pay the full cost yourself, unless you may have access to for Medicaid or have a supplemental insurance plan.

The 100-day limit resets only when you have a new benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave the nursing home. If you return to the hospital during that time and then go back to the nursing home, the days do not reset — you continue counting from where you left off.

Key Takeaways

  • Medicare covers up to 100 days in a skilled nursing facility per benefit period, but only after a three-day hospital stay.
  • You pay nothing for the first 20 days, then $200 per day (2024 rate) for days 21 through 100.
  • The facility must be Medicare-certified and provide skilled nursing or rehabilitation — not custodial care like bathing or dressing.
  • A new benefit period begins when you enter the hospital, and the 100-day clock does not reset if you return to the nursing home within 60 days of discharge.
  • Once Medicare coverage ends, Medicaid may cover long-term nursing home care if you meet income and asset limits, but the rules vary by state.

What counts as a skilled nursing facility under Medicare

Medicare only pays for care in a skilled nursing facility, not a regular nursing home or assisted living residence. The difference is the type of care provided. Skilled nursing means a registered nurse or licensed practical nurse provides medical care under a doctor's orders — wound care, medication management, physical therapy, or monitoring after surgery. Custodial care — help with bathing, dressing, eating, or toileting — is not covered by Medicare, even if a nurse is present.

Before you choose a nursing home, ask whether it is Medicare-certified and whether your specific care needs may have access to as skilled nursing. A facility may be certified for some types of care but not others. You can search for certified facilities on Medicare.gov using the Care Compare tool, which shows which services each facility provides and how Medicare rates them.

If the nursing home determines that you no longer need skilled nursing care — for example, your wound has healed and you no longer need daily nurse visits — Medicare stops paying even if you have days remaining. The facility must notify you in writing before they discharge you for this reason, and you have the right to appeal.

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 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. If you leave on Wednesday, that is only two days and Medicare will not cover the nursing home.

Observation status complicates this rule. Some hospitals admit patients under "observation" rather than as an inpatient. Observation days do not count toward the three-day requirement, even though you may be in the hospital bed for three days or more. Ask the hospital whether you are admitted as an inpatient or under observation — this is a critical distinction. If you are under observation and need a nursing home, you will pay out of pocket unless you have another insurance plan.

You must move to the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home weeks later, the hospital stay no longer counts and you do not may have access to for Medicare coverage.

How the daily costs work for days 21 through 100

For the first 20 days, Medicare Part A covers the full cost of the skilled nursing facility. Starting on day 21, you pay a daily coinsurance amount while Medicare pays the rest. This amount is set each year and changes on October 1. For 2024, the daily coinsurance is $200. For 2025, it is $205. You pay this amount for each day from day 21 through day 100.

The nursing home bills Medicare for the full cost, and you receive a bill for your share. Some people have supplemental insurance (Medigap) that covers part or all of this coinsurance. If you have Medicaid as well as Medicare, Medicaid may cover your share. Check your insurance documents or call your insurance company to see what your plan covers.

If you stay fewer than 100 days, you only pay coinsurance for the days you actually stay. If you stay 25 days, for example, you pay coinsurance for 5 days (days 21 through 25).

What happens when your 100 days end

Once you reach day 100 of your skilled nursing facility stay, Medicare stops paying. You then owe the full daily cost of the facility. For a skilled nursing facility, this can range from $200 to $400 per day or more, depending on the facility and your location.

If you cannot pay out of pocket, Medicaid may cover long-term nursing home care. Medicaid is a joint federal and state program, and each state sets its own rules for income and asset limits. In most states, you must have very limited income and assets to may have access to — often less than $2,000 in countable assets. Some states allow you to keep a home and a car. Medicaid also covers custodial care, which Medicare does not, so it can pay for help with daily living activities after your skilled care ends.

To explore Medicaid coverage, contact your state Medicaid office or a local Area Agency on Aging. The process of transferring from Medicare to Medicaid coverage can take weeks, so do not wait until day 100 to ask questions.

When a new benefit period begins and resets your coverage

A benefit period is a calendar period used by Medicare to track your use of hospital and nursing home services. It begins the day you enter a hospital and ends 60 days after you leave a hospital or nursing home, whichever is later. Once a benefit period ends, a new one begins the next time you are admitted to a hospital.

If you are discharged from a nursing home on day 50, your benefit period does not end until 60 days later. If you return to the hospital during those 60 days and then go back to the nursing home, you are still in the same benefit period. Your 100-day count continues from where it left off — it does not reset to day 1.

If you stay out of the hospital and nursing home for 60 days after discharge, a new benefit period begins. When that happens, your 100-day nursing home coverage resets. This is why the timing of readmission matters: if you are readmitted within 60 days, you lose days; if you wait longer than 60 days, you get a fresh 100 days.

How to find out how many days you have left

When you are admitted to a skilled nursing facility, the facility must give you a document called the "Notice of Medicare Coverage and Non-Coverage" within two days of admission. This notice tells you how many days Medicare will cover and when your coverage will end. Read it carefully and ask the facility to explain anything you do not understand.

You can also check your coverage online through your Medicare account at Medicare.gov. Log in, go to "My claims," and look for your nursing home claim. It will show the dates of service and the days covered.

If you disagree with the number of days Medicare says you are covered for, you have the right to appeal. You must request an appeal before you are discharged or within 30 days of discharge. The facility can tell you how to file an appeal, or you can contact Medicare directly at 1-800-MEDICARE.

Frequently Asked Questions

Does Medicare cover nursing home care without a hospital stay?

No. Medicare Part A only covers skilled nursing facility care after a three-day hospital stay. If you go directly from home to a nursing home, Medicare does not pay. You would need to pay out of pocket or use Medicaid if you may have access to.

What is the difference between Medicare and Medicaid for nursing home care?

Medicare covers up to 100 days of skilled nursing care after a hospital stay. Medicaid covers long-term nursing home care with no day limit, but only if you meet income and asset limits. Medicaid also covers custodial care, which Medicare does not. Many people use both: Medicare first, then Medicaid when Medicare ends.

Can I use my Medigap plan to cover the coinsurance for days 21 through 100?

Some Medigap plans cover part or all of the daily coinsurance. Check your plan documents or call your insurance company. Plans C, D, G, and M typically cover this cost, but coverage varies by plan and state.

What if the nursing home says I no longer need skilled care and tries to discharge me before day 100?

The facility must notify you in writing before discharging you for this reason. You have the right to appeal and request a review by Medicare. Contact Medicare at 1-800-MEDICARE or ask the facility for help filing an appeal.

If I leave the nursing home on day 50 and return on day 55, do I lose my remaining days?

No. If you return within 60 days of discharge, you are still in the same benefit period and your 100-day count continues. You would have 50 days of coverage remaining. If you return after 60 days, a new benefit period begins and you get a fresh 100 days.