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

Medicare pays for skilled nursing facility care only after a hospital stay, and only for a set number of days. The program covers up to 100 days per benefit period, but most people's coverage ends much sooner — often between 20 and 30 days — because Medicare stops paying once you no longer need daily skilled care. After Medicare stops, you pay out of pocket, Medicaid takes over (if you meet income and asset limits), or you rely on long-term care insurance if you have it.

The key word is skilled care. Medicare does not pay for custodial care — help with bathing, dressing, meals, or daily living — even in a nursing home. It pays only when you need medical services that require a nurse or therapist: wound care, intravenous medication, physical therapy after surgery, or monitoring for a serious condition. Once you can manage those tasks yourself or with family help, Medicare's payment stops.

Key Takeaways

  • Medicare covers up to 100 days in a skilled nursing facility per benefit period, but only after a hospital stay of at least three days.
  • You pay nothing for days 1–20, a daily copay (currently $194 per day in 2024, though this changes yearly) for days 21–100, and all costs after day 100.
  • Most people's coverage ends between day 20 and day 30 because Medicare stops paying once skilled care is no longer medically necessary, not because the 100-day limit is reached.
  • When Medicare stops paying, you must pay privately, switch to Medicaid (if you meet the income and asset test), or leave the facility.
  • The facility must tell you in writing when Medicare will stop paying, usually three days before it happens.

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. The stay must be for an acute medical condition — not observation, not outpatient surgery, but admission as an inpatient. The three days count from midnight of your first full day in the hospital, not from arrival time.

This rule trips up many people. If you have outpatient surgery or spend fewer than three days in the hospital, Medicare will not cover nursing home care afterward, even if your doctor says you need it. You will have to pay privately or use Medicaid if you may have access to. Some facilities will admit you anyway and bill you directly; others will not admit you until you have met the three-day requirement.

How the 100-day benefit period works

Medicare's nursing home benefit resets each time you have a new benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the skilled nursing facility. If you are readmitted to the hospital within that 60-day window, the same benefit period continues. If you stay out of the hospital for 60 days, a new benefit period begins with your next hospital admission.

Within each benefit period, Medicare covers up to 100 days total in a skilled nursing facility. You do not have to use all 100 days at once — if you go home after 30 days and are readmitted within the same benefit period, the remaining 70 days are still available. Once the benefit period ends, the 100-day count resets.

What you pay: copays and when they start

Days 1 through 20 are fully covered by Medicare — you pay nothing. Starting on day 21, you owe a daily copay. The copay amount changes each year; in 2024 it is $194 per day, but check with your facility or Medicare for the current year's amount. You pay this copay for days 21 through 100. After day 100, you pay the full cost of the facility.

The facility bills Medicare directly for the covered portion. You will receive a bill from the facility for your copay share. Some facilities ask you to pay the copay as you go; others bill you after discharge. Ask the admissions office how they handle billing before you arrive.

Why Medicare stops paying before day 100

Most people's Medicare coverage ends long before they reach 100 days. Medicare stops paying the moment you no longer need skilled nursing care — care that requires a licensed nurse or therapist to deliver safely. This includes wound dressing changes, intravenous medications, catheter care, physical therapy, occupational therapy, and speech therapy ordered by a doctor.

If you improve and can manage your medications yourself, your wounds are healed, and you no longer need therapy, Medicare considers you ready to leave. The facility must notify you in writing at least three days before Medicare stops paying. This notice is called a Notice of Non-Coverage or discharge notice. You have the right to appeal the decision if you believe you still need skilled care, but you must request the appeal before you leave or within a short window after.

Custodial care — help with bathing, dressing, toileting, meals, and daily activities — is not covered by Medicare, even if you need it and cannot do it alone. If that is all you need, you must pay privately or use Medicaid.

What happens when Medicare coverage ends

When Medicare stops paying, you have three main options: pay out of pocket, switch to Medicaid, or go home. The facility cannot force you to leave, but they can require you to pay the full daily rate, which is usually $300 to $500 per day or more, depending on the facility and your location.

If you have limited income and assets, you may be able to switch to Medicaid, which covers long-term custodial care with no time limit. Medicaid rules vary by state, but generally you must have less than $2,000 in countable assets (rules differ for married couples). The facility's social worker can help you understand whether you may have access to and how to start the Medicaid process. Some facilities will let you stay while Medicaid processes your process; others require payment upfront.

If you have long-term care insurance, check your policy to see whether it covers nursing home care and when the benefit begins. Some policies start paying after Medicare stops; others have a waiting period or daily benefit limit.

How to find out when your coverage will end

Ask the facility's billing or social work department for a written estimate of how long Medicare will cover your stay. They base this on your doctor's orders and your progress in therapy. The estimate is not a may provide — if you improve faster or slower than expected, the date may change.

You will receive a formal Notice of Non-Coverage at least three days before Medicare stops paying. Read it carefully. It will tell you the exact date coverage ends and explain your right to appeal. If you disagree with the decision, you can request an appeal through Medicare, but you must act quickly — usually within a few days of receiving the notice.

If you have Original Medicare (not a Medicare Advantage plan), you can also request an independent review by a Quality Improvement Organization (QIO). The facility or your doctor can help you request this review.

Medicare Advantage and nursing home coverage

If you have a Medicare Advantage plan instead of Original Medicare, the same 100-day limit and three-day hospital stay requirement explore. However, your plan may have different rules about which facilities are in-network, how much you pay, and how the plan handles the non-coverage notice. Contact your plan directly to understand your coverage before you are admitted.

Some Medicare Advantage plans cover additional days or services that Original Medicare does not, but this varies widely. Ask your plan whether they cover any custodial care or extended stays, and get the answer in writing.

Frequently Asked Questions

Can I appeal if Medicare says I no longer need skilled care?

Yes. You have the right to request an appeal if you receive a Notice of Non-Coverage. You must request the appeal before you leave the facility or within a short window after (usually a few days). You can ask for an independent review by a Quality Improvement Organization. The facility's social worker or your doctor can help you file the appeal.

Does Medicare cover nursing home care without a hospital stay?

No. You must have a hospital stay of at least three consecutive days as an inpatient before Medicare will cover nursing home care. Observation stays and outpatient procedures do not count. If you need nursing home care without a prior hospital stay, you must pay privately or use Medicaid if you may have access to.

What is the difference between skilled nursing care and custodial care?

Skilled care requires a nurse or therapist — wound care, intravenous medication, physical therapy, catheter management. Custodial care is help with daily living: bathing, dressing, meals, toileting. Medicare covers skilled care for up to 100 days; it does not cover custodial care at all, even in a nursing home.

If I go home and come back to the same nursing home, do I lose my remaining days?

No, if you are readmitted within the same benefit period (within 60 days of leaving the facility). Your remaining days from the 100-day limit are still available. If you stay out longer than 60 days, a new benefit period begins and you get a fresh 100 days, but only if you have another may have access to hospital stay.

What if I cannot afford the copay for days 21–100?

Talk to the facility's social worker or billing department. Some facilities work with patients on payment plans. You may also be able to use Medicaid to cover the copay if you meet income and asset limits. Some charitable organizations and local aging agencies offer financial information, though availability varies by location.