Medicare covers up to 100 days in a nursing home per benefit period, but only if you meet specific conditions

Medicare will pay for skilled nursing care — not custodial care or long-term residential placement — and only after you have spent at least three consecutive days in a hospital. The coverage breaks down into two payment tiers: Medicare pays the full cost for days 1 through 20, and you pay a daily coinsurance amount for days 21 through 100. After day 100, Medicare stops paying and you become responsible for all costs.

The catch is that Medicare must determine your stay is medically necessary. A doctor has to order the nursing home care as part of your recovery from an acute illness or injury, and a Medicare-certified nursing home must accept you. If you are admitted for custodial care — help with bathing, dressing, or daily living — rather than skilled nursing or rehabilitation, Medicare will not pay from day one.

Key Takeaways

  • Medicare covers a maximum of 100 days per benefit period, with full coverage for days 1–20 and shared costs for days 21–100.
  • You must have spent at least three consecutive days in a hospital before Medicare will pay for nursing home care.
  • The nursing home must be Medicare-certified, and a doctor must order the care as medically necessary recovery, not custodial information.
  • Your benefit period resets each year, and if you need care again after your 100 days end, a new hospital stay can start a new benefit period.
  • If Medicare stops paying before you are ready to leave, you can request a review, but the nursing home must notify you in writing before discharge.

The three-day hospital stay requirement

Before Medicare will pay for any nursing home days, you must first be admitted to a hospital and stay for at least three consecutive days. Observation stays — where you are in the hospital but not formally admitted — do not count. The three days must be inpatient admission days, and they must be consecutive, meaning you cannot count three separate visits spread across a month.

The hospital stay does not have to be for the same condition you are being treated for in the nursing home, but it must be related enough that the nursing home care is considered a continuation of your hospital treatment. For example, if you were hospitalized for pneumonia and then admitted to a nursing home for physical therapy and wound care, the connection is clear. If you were hospitalized for a broken leg and then admitted to a nursing home for memory care, Medicare is unlikely to pay.

The three-day clock starts when you are formally admitted as an inpatient, not when you arrive at the emergency department. Ask the hospital to confirm in writing that you have been admitted as an inpatient and when your three-day requirement will be met. This documentation matters if there is a dispute later about whether you meet the threshold.

What counts as skilled nursing care versus custodial care

Medicare distinguishes between skilled nursing care and custodial care. Skilled care is medical treatment that requires a nurse or therapist — wound dressing, medication management, physical therapy, occupational therapy, or speech therapy. Custodial care is help with activities of daily living — bathing, dressing, toileting, eating, or transferring in and out of bed — even if a nurse provides it.

The line between the two is not always obvious. If you need a nurse to change a surgical wound dressing, that is skilled care. If you need a nurse to help you bathe because you cannot do it yourself, that is custodial care. If you need physical therapy to regain the ability to walk after a stroke, that is skilled care. If you need someone to help you walk to the bathroom, that is custodial care.

Medicare will pay only for the skilled care portion of your stay. If you are in a nursing home receiving both skilled and custodial care, Medicare covers the skilled portion. Once your skilled care needs end — for example, once your wound is healed and you no longer need daily dressing changes — Medicare stops paying, even if you still need custodial care and want to stay in the facility.

How the 100-day limit and cost-sharing work

Your 100-day limit is per benefit period, not per calendar year. A benefit period begins the day you are admitted to a hospital and ends 60 days after you leave the hospital or nursing home, whichever is later. If you are readmitted to a hospital before your current benefit period ends, the days do not reset — you are still in the same benefit period and the same 100-day nursing home limit applies.

Within those 100 days, Medicare pays differently depending on which day you are on. Days 1 through 20 are fully covered by Medicare — you pay nothing (except your Part A deductible, which you pay once per benefit period). Days 21 through 100 require you to pay a daily coinsurance amount. This coinsurance amount changes each year; you can find the current amount on Medicare.gov or by calling 1-800-MEDICARE.

If you stay beyond day 100, Medicare pays nothing. You and your family become responsible for the full cost of nursing home care. Some people have long-term care insurance or Medicaid that covers costs after Medicare stops, but Medicare itself does not.

When your benefit period resets and you can get another 100 days

If you need nursing home care again after your current benefit period ends, a new hospital admission starts a new benefit period and a new 100-day count. For example, if your first benefit period ends in March and you are hospitalized again in June, you begin a new benefit period in June with a fresh 100 days of nursing home coverage.

However, if you are still in the nursing home when your benefit period ends, you do not automatically get another 100 days. Your benefit period ends 60 days after you leave the hospital or nursing home. If you are still receiving skilled care at that point, Medicare continues to pay until either your skilled care needs end or you reach day 100, whichever comes first. After that, you must be discharged or transition to another payment source.

Some people cycle through multiple benefit periods if they have repeated hospitalizations. Each new hospital admission can trigger a new benefit period and another 100 days of potential nursing home coverage. There is no annual limit on how many benefit periods you can have, only a limit per benefit period.

What happens when Medicare stops paying

When Medicare determines that your skilled care needs have ended or you have reached day 100, the nursing home must notify you in writing at least two days before discharge or before you stop receiving Medicare-covered care. This notice is called a Notice of Non-Coverage. You have the right to request a review if you disagree with the decision.

If you request a review, Medicare will send an independent reviewer — called a Quality Improvement Organization (QIO) — to assess whether your skilled care needs have truly ended. This review is free. If the QIO agrees with Medicare, you are responsible for payment. If the QIO disagrees, Medicare continues to pay while the review is underway and for any days the QIO determines should have been covered.

Before the nursing home can discharge you, they must may support you have a safe place to go. If you have nowhere to go and cannot afford private pay, the nursing home social worker can help you explore Medicaid, which may cover long-term nursing home care if you meet income and asset limits. Medicaid rules vary by state, so ask the social worker about your state's program.

How to track your days and prepare for the end of coverage

Keep a record of the dates you were admitted to the hospital and the nursing home, and ask the nursing home to give you a written summary of your stay and the days Medicare has paid for. You can also call Medicare at 1-800-MEDICARE and ask them to tell you how many days you have used and how many remain in your current benefit period.

About two weeks before you expect to reach day 100 or before your skilled care needs are likely to end, start planning your next step with the nursing home social worker. Ask whether you might be discharged to home, whether you might transition to a different level of care (such as assisted living), or whether Medicaid might cover continued nursing home care. Do not wait until the discharge notice arrives to have this conversation.

If you have supplemental insurance (Medigap) or long-term care insurance, review your policy to see whether it covers nursing home care after Medicare stops. Some policies do; many do not. Knowing what your insurance covers helps you plan and avoid surprises.

Frequently Asked Questions

Do the three days in the hospital have to be right before I go to the nursing home?

No. You can be discharged from the hospital, go home for a few days, and then be admitted to a nursing home, and Medicare will still pay if the nursing home care is related to your hospital treatment. However, if you are discharged and then readmitted to the hospital again before going to the nursing home, the three-day requirement starts over with the second hospital stay.

What if I run out of Medicare coverage but still need skilled care?

You can request a review by the Quality Improvement Organization if you believe your skilled care needs have not ended. If the review upholds Medicare's decision, you can ask the nursing home about Medicaid, private pay options, or discharge to home with home health services. Some people transition to home health care, which Medicare covers separately if a doctor orders it.

Can I use my 100 days across multiple nursing homes?

Yes. Your 100-day limit is per benefit period, not per facility. If you are discharged from one nursing home and admitted to another while still in the same benefit period, the days you used at the first home count toward your 100-day total at the second home.

Does Medicare pay for a private room in the nursing home?

Medicare pays the facility's standard rate regardless of room type. If you choose a private room and the nursing home charges more for it, you pay the difference out of pocket, in addition to any coinsurance you already owe for days 21–100.

What if I am in the nursing home on day 100 and my doctor says I still need skilled care?

Medicare stops paying after day 100, even if your doctor believes you still need care. You can request a review, but the burden is on you to show that your skilled care needs have not ended. If the review does not overturn the decision, you must find another way to pay or be discharged.