Medicare covers skilled nursing care for a limited time, not permanent residence

Medicare will pay for nursing home care only if you need skilled nursing care — medical services like wound care, IV therapy, or physical therapy that require a nurse or therapist. It does not pay for custodial care, which is help with daily activities like bathing, dressing, or meals. The length of coverage depends on your recovery progress and whether Medicare determines the care is medically necessary.

Medicare Part A covers up to 100 days in a nursing home per benefit period, but you will not receive full coverage for all 100 days. You pay nothing for days 1 through 20. From day 21 onward, you pay a daily coinsurance amount (in 2024, this is $200 per day). After day 100, Medicare coverage ends and you pay the full cost yourself.

A benefit period begins the day you enter the hospital or nursing home and ends 60 days after you have not received hospital or skilled nursing care. If you return to the hospital or nursing home after that 60-day gap, a new benefit period starts and your day count resets to 1.

Key Takeaways

  • Medicare Part A covers up to 100 days of skilled nursing care per benefit period, but only if a doctor orders it as part of your recovery from a hospital stay or acute illness.
  • You pay nothing for days 1–20, then a daily coinsurance amount for days 21–100; Medicare pays nothing after day 100.
  • A benefit period ends 60 days after you leave the hospital or nursing home, and a new one begins if you return.
  • Medicare will stop paying before day 100 if your doctor determines you no longer need skilled care or are not making progress toward recovery.
  • Medigap or Medicare Advantage plans may cover some or all of the coinsurance you owe, depending on the plan.

What counts as skilled nursing care under Medicare

Skilled nursing care means medical services that must be performed or supervised by a licensed nurse, or therapy services provided by a licensed therapist. Examples include wound dressing changes, catheter care, intravenous medications, physical therapy after a hip fracture, occupational therapy to regain function, and speech therapy after a stroke.

Custodial care — help with bathing, dressing, toileting, eating, or moving around — does not may have access to, even if a nursing home provides it. If you need only custodial care, Medicare will not pay. You or your family will pay out of pocket, or you may turn to Medicaid if you meet income and asset limits.

A doctor must order the skilled care, and you must have been an inpatient in a hospital for at least three consecutive days (not counting the discharge day) in the three days before you enter the nursing home. This is called the "three-day rule." If you go directly to a nursing home from home or an outpatient clinic, Medicare will not cover it.

When Medicare stops paying before day 100

Medicare can end coverage before you reach 100 days if your doctor determines you no longer need skilled care or are not making progress toward recovery. The nursing home must notify you in writing before they stop billing Medicare, and you have the right to appeal the decision.

Progress does not mean you must improve every day. It means your condition is stable and you are working toward a specific goal — such as learning to walk with a walker, managing a new medication, or regaining enough strength to go home. If your condition plateaus and skilled care is no longer medically necessary, Medicare coverage ends.

You will receive a notice called a Notice of Non-Coverage before the nursing home stops billing Medicare. Read it carefully. If you disagree with the decision, you can request a review by a peer review organization. You have limited time to request this review, so act quickly if you believe the decision is wrong.

How your benefit period works and when it resets

Your benefit period is tied to your hospital or nursing home stay, not to the calendar year. It begins the day you are admitted to a hospital or nursing home and ends 60 days after you have not received hospital or skilled nursing care.

If you leave the nursing home on day 30 and do not return to a hospital or nursing home for 60 days or more, your benefit period ends. If you return on day 61, a brand new benefit period begins and your day count resets to 1. This means you get another 100 days of potential coverage.

If you return to the hospital or nursing home within 60 days of leaving, you continue in the same benefit period. Your day count does not reset. For example, if you used 45 days in the nursing home, left for 30 days, and returned to the hospital, you would have 55 days of nursing home coverage remaining in that same benefit period.

What you pay out of pocket

For days 1 through 20, Medicare Part A covers 100 percent of the cost of skilled nursing care (room, board, meals, nursing care, therapy, and medications). You pay nothing during these days, though you may owe a hospital deductible if you have not met it yet in that benefit period.

For days 21 through 100, you pay a daily coinsurance amount. In 2024, this amount is $200 per day. Medicare pays the rest. This coinsurance amount changes each year.

After day 100, you pay the entire cost of the nursing home. There is no Medicare coverage. If you have a Medigap policy (supplemental insurance), it may cover some or all of this coinsurance. If you have a Medicare Advantage plan, your coverage and costs vary by plan — check your plan documents or call the plan to learn what you owe.

Planning ahead if you might need long-term nursing home care

If you think you may need nursing home care beyond 100 days, or if you need custodial care that Medicare does not cover, you have several options to explore now.

Long-term care insurance is a separate policy you buy before you need care. It covers custodial care and can extend coverage beyond what Medicare provides. Premiums depend on your age and health when you buy the policy. Many people buy it in their 50s or 60s.

Medicaid covers long-term nursing home care if you meet income and asset limits. Limits vary by state. Medicaid covers both skilled and custodial care. If you think you might need long-term care, speak with an elder law attorney or your state Medicaid office about planning ahead.

Some people use their savings or family resources to pay for care beyond Medicare's 100 days. Others move to assisted living or home care as an alternative. Talking with your family and a financial advisor now can help you understand your options before a crisis forces the decision.

What to ask your doctor and nursing home

Before you enter a nursing home, ask your doctor: "Will Medicare cover this stay?" and "How long do you expect I will need skilled nursing care?" Ask the nursing home to explain the three-day hospital rule and confirm that your hospital stay meets it.

Once you are in the nursing home, ask the staff: "How many days of Medicare coverage do I have left?" and "What is my daily coinsurance cost?" Request a written summary of your coverage and costs. Ask what happens when Medicare coverage ends and what your options are at that point.

If you receive a Notice of Non-Coverage, ask the nursing home to explain why Medicare is stopping coverage and ask for the peer review organization's contact information so you can request an appeal if you disagree.

Frequently Asked Questions

Does Medicare cover nursing home care if I did not spend three days in the hospital first?

No. Medicare requires a three-day inpatient hospital stay in the three days before you enter the nursing home. If you go directly from home or an outpatient clinic to a nursing home, Medicare will not pay. You would need to pay out of pocket or turn to Medicaid if you meet the income and asset limits.

What if I run out of Medicare coverage before I am ready to leave?

After day 100, you pay the full cost of the nursing home yourself. If you cannot afford it, speak with the nursing home social worker about Medicaid, payment plans, or other resources. Some nursing homes have financial information programs. You may also need to explore moving to a less expensive setting, such as assisted living or home care.

Can I use my Medicare Advantage plan instead of Part A for nursing home care?

Medicare Advantage plans must cover at least what Original Medicare (Part A and Part B) covers. However, your out-of-pocket costs and the specific rules may differ. Contact your plan before you enter a nursing home to learn what it covers and what you will owe.

If I leave the nursing home and come back within 60 days, do I start over at day 1?

No. If you return within 60 days, you stay in the same benefit period and your day count continues from where it left off. You only reset to day 1 if you have been out of the hospital and nursing home for 60 days or more.

Does my Medigap insurance cover the nursing home coinsurance?

Some Medigap plans do cover part or all of the daily coinsurance for days 21–100. Check your policy documents or call your Medigap insurer to learn what is covered. Not all Medigap plans include this benefit.