Medicare covers some nursing home costs, but not all — and only under specific conditions
Medicare pays for skilled nursing facility care only after a hospital stay of at least three days, and only for the first 100 days. You pay nothing for days 1–20. From day 21 onward, you pay a daily copay that changes each year (in 2024, it is $194.50 per day). After day 100, Medicare stops paying and you cover the full cost yourself.
The catch: Medicare does not pay for custodial care — help with bathing, dressing, eating, or toileting — which is what most nursing home residents need long-term. It pays only for skilled care: wound care, physical therapy, medication management, or other services that require a nurse or therapist. If you need custodial care alone, Medicare does not cover it, period.
The actual cost of a nursing home bed varies widely by location and facility type. A semi-private room costs between $6,000 and $12,000 per month on average, though some facilities charge more. A private room typically costs 10 to 20 percent more. These are out-of-pocket costs when Medicare is not paying, or costs you owe after Medicare's coverage ends.
Key Takeaways
- Medicare covers skilled nursing facility care for up to 100 days after a hospital stay of three days or more, with no cost for days 1–20 and a daily copay for days 21–100.
- Medicare does not cover custodial care (help with daily living), which is what most long-term nursing home residents need and what makes up the bulk of the monthly bill.
- After Medicare coverage ends or if you do not meet the hospital-stay requirement, you pay the full nursing home cost out of pocket, typically $6,000 to $12,000 per month for a semi-private room.
- Medicaid, not Medicare, is the program that covers long-term custodial nursing home care for people with limited income and assets, though rules vary by state.
- The difference between what Medicare covers and what a nursing home costs is why most people who stay long-term rely on Medicaid, private insurance, or personal savings.
The three-day hospital stay requirement and what it means
To get Medicare to pay for any nursing home care, you must be admitted to a hospital as an inpatient for at least three consecutive days. Observation stays do not count — you must be formally admitted. The three days must happen within 30 days before you enter the nursing home, and your doctor must order the nursing home care as part of your discharge plan.
This rule eliminates many people from Medicare coverage. If you fall at home, go to the emergency room, get treated, and go home, that does not trigger coverage. If you are in the hospital for two days and then discharged to a nursing home, you do not may have access to. You need the full three-day inpatient stay, documented in your hospital record.
When you are discharged from the hospital, ask the discharge planner whether your stay counts toward the three-day requirement. If it does not, ask whether staying one more day would change that. Some people can negotiate the timing of discharge to meet the requirement, though the hospital makes the final decision based on medical need.
What Medicare actually pays for in a nursing home
Medicare covers the cost of the bed, meals, and basic nursing services. It also covers skilled nursing care, physical therapy, occupational therapy, and speech therapy — but only if those services are medically necessary and ordered by your doctor. It does not cover the therapist's time if you are there only for custodial reasons.
The facility bills Medicare directly for covered services. You do not pay the facility upfront and then seek reimbursement. However, you are responsible for any services Medicare does not cover, and the facility will bill you for those.
Common services Medicare does not cover in a nursing home include: help with bathing, dressing, grooming, or toileting; meal preparation; housekeeping; laundry; transportation; phone service; television; and personal care attendants. These are custodial services, and they are your responsibility to pay for, even while Medicare is covering your skilled care.
Your costs during the first 100 days
| Days | Your Cost | What Medicare Covers |
|---|---|---|
| 1–20 | $0 | 100% of covered skilled care |
| 21–100 | $194.50 per day (2024) | 100% of covered skilled care after you pay the copay |
| 101+ | 100% of all costs | Nothing |
The daily copay applies only to days 21 through 100. It is not a percentage of the bill — it is a flat amount per day. If the nursing home charges $300 per day and Medicare's copay is $194.50, you pay $194.50 and Medicare pays $105.50. If the home charges $500 per day, you still pay only $194.50 and Medicare pays $305.50.
The copay amount changes each year. Check Medicare.gov or call 1-800-MEDICARE to confirm the current year's amount before you are admitted.
These costs assume the nursing home is Medicare-certified and that the care you receive qualifies as skilled care. If the facility is not certified or if your care does not meet Medicare's definition of skilled, Medicare will not pay anything, and you owe the full bill.
What happens after day 100
Medicare coverage ends on day 100. From that point forward, you are responsible for the entire cost of the nursing home — typically $6,000 to $12,000 per month, depending on location and facility type.
At this point, most people turn to Medicaid if they have limited income and assets. Medicaid is a state-run program that covers long-term custodial nursing home care, and it is the primary payer for nursing home residents in the United States. However, Medicaid has strict income and asset limits, and you may need to spend down your savings to become may be able to access.
If you do not may have access to for Medicaid and cannot pay out of pocket, talk to the facility's social worker or financial counselor. Some facilities have payment plans, charitable funds, or connections to local nonprofits that help with costs. Some people also explore long-term care insurance, though policies are expensive and have waiting periods.
How to prepare before you need a nursing home
If you think you may need nursing home care in the future, understand now what Medicare will and will not cover. Review your Medicare Summary Notice (the statement you receive quarterly) to see what skilled services Medicare has paid for in the past. This gives you a sense of what the program considers medically necessary.
Ask your doctor whether you have conditions that might require skilled nursing care later — wound care, dialysis, physical therapy after surgery, or medication management. If so, understand that Medicare will cover only the skilled portion, not the custodial portion.
Consider whether you have savings to cover the gap between what Medicare pays and what a nursing home costs. If you do not, research Medicaid rules in your state now, while you are healthy. Medicaid has a five-year lookback period for asset transfers, meaning if you give away money or property to become may be able to access, Medicaid may penalize you. Planning ahead avoids this trap.
Frequently Asked Questions
Does Medicare cover nursing home care if I did not have a three-day hospital stay?
No. Medicare requires a three-day inpatient hospital stay within 30 days before admission to a nursing home. Observation stays, emergency room visits, or outpatient procedures do not count. If you do not meet this requirement, Medicare will not pay for any nursing home care, and you cover the full cost yourself.
What is the difference between Medicare and Medicaid for nursing homes?
Medicare is federal insurance for people 65 and older and covers short-term skilled care after a hospital stay. Medicaid is a state-run program for people with low income and assets and covers long-term custodial care. Most nursing home residents rely on Medicaid for long-term stays because Medicare coverage ends after 100 days.
Can I use my Medigap or Medicare Advantage plan to cover nursing home costs?
Medigap plans cover the daily copay you owe during days 21–100, but they do not extend coverage beyond day 100. Medicare Advantage plans vary — some cover additional days or services, but most follow the same 100-day limit as Original Medicare. Check your plan documents or call your plan to see what nursing home coverage you have.
What if the nursing home charges more than Medicare pays?
During days 1–20, Medicare covers the full cost of covered services, so the facility cannot charge you more. During days 21–100, you pay the copay and Medicare pays its portion. If the facility's actual cost exceeds what Medicare pays, the facility absorbs the difference — they cannot bill you for it. This is called "balance billing," and it is illegal in nursing homes.
How do I know if a nursing home is Medicare-certified?
Check the facility's Medicare certification status on Medicare.gov or call 1-800-MEDICARE. You can also ask the facility directly. If a home is not certified, Medicare will not pay for any care there, even if you meet the three-day hospital stay requirement.