Medicare covers nursing home care for a limited time, not indefinitely

Medicare pays for skilled nursing facility (SNF) care for up to 100 days per benefit period, but only if you meet specific conditions. You must have been in a hospital for at least three consecutive days, enter the nursing home within 30 days of hospital discharge, and need daily skilled care — not just help with daily activities. The facility must be Medicare-certified. After 100 days, you pay the full cost yourself unless you have Medicaid, a supplemental insurance plan, or other coverage.

The payment structure changes at day 21. Days 1 through 20 are fully covered by Medicare with no out-of-pocket cost. From day 21 onward, you pay a daily coinsurance amount (this amount changes each year; in 2024 it is $194.50 per day). After day 100, Medicare stops paying entirely for that benefit period.

Key Takeaways

  • Medicare covers up to 100 days of skilled nursing facility care per benefit period, but only after a hospital stay of at least three consecutive days.
  • Days 1 through 20 are fully covered; from day 21 onward you pay a daily coinsurance amount that Medicare does not cover.
  • The nursing home must be Medicare-certified and you must need skilled care (wound care, physical therapy, medication management) — not just information with bathing or dressing.
  • If you need nursing home care beyond 100 days, Medicaid, long-term care insurance, or personal funds become your payment source.
  • A new benefit period begins on October 1 each year, resetting your 100-day count even if you did not use all days in the previous period.

What counts as a may have access to hospital stay

The hospital stay must be at least three consecutive days — meaning three midnights in the hospital, not three calendar days. The day you are admitted does not count; the count starts the next day. If you are admitted on a Monday and discharged on Thursday morning, that is three midnights (Monday night, Tuesday night, Wednesday night) and qualifies.

Observation status does not count as an inpatient stay, even if you spend multiple days in the hospital. If your hospital records show you were on "observation" rather than admitted as an inpatient, you do not meet the three-day requirement. This is a common source of confusion because observation patients can stay in a hospital bed for days but not trigger SNF coverage. You can ask the hospital to review your status if you believe it was coded incorrectly.

You must enter the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home two months later, that nursing home stay is not covered by Medicare, even if you were hospitalized before.

What "skilled care" means and what it does not

Skilled care means medical or rehabilitative services that require a licensed nurse or therapist to perform or supervise. Examples include wound dressing changes, intravenous medication administration, physical therapy after a stroke or joint replacement, occupational therapy, speech therapy, and catheter care. If a nursing home can document that you need one of these services daily or several times per week, Medicare will cover your stay.

Help with activities of daily living — bathing, dressing, toileting, eating — is not skilled care, even if you need help with all of them. A facility that provides only custodial care (information with daily activities) is not a skilled nursing facility and is not covered by Medicare. If your condition improves and you no longer need skilled services, Medicare coverage ends, even if you are still in the facility and still need help with daily tasks.

The nursing home must document your need for skilled care in your medical record. If the documentation is weak or absent, Medicare may deny payment retroactively. Ask the facility's social worker or discharge planner to explain in writing why your care qualifies as skilled before you are admitted.

How the 100-day benefit period works

Each benefit period runs from October 1 to September 30. You get a fresh 100-day count each year, regardless of whether you used your previous days. If you used 60 days in one benefit period, you start the next period with 100 days available again.

The 100 days do not have to be consecutive. If you are in a nursing home for 30 days, are discharged, and then readmitted to a nursing home 45 days later, both stays count toward your 100-day total for that benefit period. You would have 25 days of coverage remaining.

Once you reach day 100 in a benefit period, Medicare coverage stops. If you are still in the nursing home on day 101, you become responsible for the full daily cost. Some facilities will work with you on payment plans; others will discharge you if you cannot pay. This is why understanding your coverage limit before you need it matters.

What you pay out of pocket

Days 1 through 20: You pay nothing. Medicare covers 100 percent of the cost of the skilled nursing facility, including room, board, meals, and skilled nursing care.

Days 21 through 100: You pay a daily coinsurance amount. This amount is set by Medicare each year and changes on January 1. You are responsible for this daily amount; Medicare covers the rest. The facility bills you directly for this coinsurance.

Day 101 onward: You pay the full daily cost of the facility. This can range from $200 to $400 per day or more, depending on the facility and your location. This is why many people purchase long-term care insurance or plan to use Medicaid if they anticipate a long nursing home stay.

Medicare does not cover medications, medical equipment (like a wheelchair or walker), or services not related to your skilled care need. Your supplemental insurance (Medigap) may cover some of these costs; check your policy.

When coverage ends before 100 days

Medicare stops paying before day 100 if you no longer need skilled care. A doctor or the facility's care team must determine that your condition has improved enough that you no longer require daily skilled nursing or therapy. This decision is made by the facility, not by Medicare directly, but Medicare will not pay if the facility cannot document ongoing skilled care needs.

If you disagree with the decision to end coverage, you have the right to appeal. The facility must give you written notice at least two days before they plan to discharge you. You can request a detailed explanation of why skilled care is ending and can ask for a peer review by an independent reviewer. The process takes time, so act quickly if you want to challenge the decision.

Some people transition from Medicare-covered skilled care to custodial care in the same facility, paying out of pocket for the custodial portion. Others are discharged to home care or to a different setting. Ask the facility's social worker about your options before coverage ends.

Medicaid and other coverage after Medicare ends

If you need nursing home care beyond 100 days and do not have the funds to pay privately, Medicaid may cover the cost. Medicaid is a joint federal-state program, and each state sets its own rules about nursing home coverage. Some states cover nursing home care more generously than others. You must meet income and asset limits to may have access to for Medicaid, and you may need to spend down your savings first.

Long-term care insurance, if you have it, typically begins paying after Medicare ends or after a waiting period. Review your policy to understand when benefits start and what daily amount is covered.

A Medigap (supplemental insurance) policy does not cover nursing home care beyond what Medicare covers. Some Medigap plans cover the daily coinsurance on days 21 through 100, but none cover days 101 onward.

Frequently Asked Questions

Do I need to be admitted to the hospital to get Medicare nursing home coverage?

Yes. You must have been an inpatient in a hospital for at least three consecutive days and enter the nursing home within 30 days of discharge. If you go directly from home to a nursing home without a hospital stay, Medicare will not pay, even if you need skilled care.

What happens if the nursing home is not Medicare-certified?

Medicare will not pay for your care at a non-certified facility, even if you meet all other requirements. Always confirm the facility is Medicare-certified before admission. You can check this on Medicare.gov or by calling the facility directly.

Can I use Medicare for a nursing home stay that started before I turned 65?

No. Medicare coverage only applies to people age 65 and older (or those under 65 with certain disabilities or end-stage renal disease). If you entered a nursing home before you were may be able to access for Medicare, that stay is not covered retroactively once you turn 65.

If I leave the nursing home and come back, do I lose my remaining days?

Your remaining days stay with you within the same benefit period (October 1 to September 30). If you use 40 days, are discharged, and readmitted within the same benefit period, you have 60 days left. Once a new benefit period begins on October 1, your count resets to 100.

What should I do if Medicare denies payment for my nursing home stay?

Request an explanation in writing from both Medicare and the facility. You have the right to appeal. Contact your state's Medicare beneficiary advocate or your local Area Agency on Aging for help understanding the denial and filing an appeal.