Medicare covers some nursing home costs, but only under specific conditions and only for a limited time

Medicare pays for skilled nursing facility (SNF) care — not custodial nursing home care. The difference matters. Skilled nursing means you need medical care that requires a nurse or therapist: wound care after surgery, physical therapy after a fall, intravenous medications, or monitoring for a new condition. Custodial care — help with bathing, dressing, meals, and daily living — is not covered by Medicare, even in a nursing home.

If you meet Medicare's conditions, it covers the full cost of your first 20 days in a Medicare-approved facility. From day 21 through day 100, you pay a daily copay (the amount changes each year; in 2024 it is $194 per day). After day 100 in the same benefit period, Medicare pays nothing. You would pay the full cost yourself or use other insurance, like Medicaid or a long-term care policy.

Most people do not stay in a nursing home long enough to hit day 100. Many leave after two to four weeks of therapy and go home. But if you do stay longer, the costs add up quickly.

Key Takeaways

  • Medicare covers skilled nursing care (medical treatment by nurses or therapists) for up to 100 days per benefit period, but only if you were hospitalized for at least three days first.
  • You pay nothing for days 1 through 20, then a daily copay for days 21 through 100; after day 100, Medicare stops paying and you cover the full cost.
  • Custodial care — help with bathing, dressing, and daily tasks — is never covered by Medicare, even in a nursing home.
  • The facility must be Medicare-approved and your doctor must order the care; you cannot choose a nursing home and have Medicare pay for it on your own.
  • If you run out of Medicare coverage and cannot pay, Medicaid may cover long-term nursing home care, but rules vary by state.

The three-day hospital stay requirement

Medicare will only pay for nursing home care if you spent at least three days as an inpatient in a hospital first. The three days must be for the same condition you need nursing home care for — or a related one. A three-day observation stay does not count; you must be admitted as an inpatient.

This rule trips up many people. You might spend three days in the hospital, be discharged home, and then fall or get sick a week later and need nursing home care. That later stay would not may have access to because it was not connected to the hospital stay. You would have to pay out of pocket or use another source of coverage.

Ask the hospital before discharge whether your stay counts as inpatient admission. The hospital's billing department can confirm this. If you are unsure, ask your doctor or the discharge planner whether the nursing home care you need will be covered by Medicare.

How the 100-day limit works

The 100 days are per benefit period, not per year. A benefit period starts the day you enter the hospital and ends 60 days after you leave the nursing home. If you go home and then return to a nursing home within 60 days, you are still in the same benefit period and your day count continues where it left off.

If you leave the nursing home and stay home for 60 days or longer, a new benefit period starts. You get a fresh 100 days of coverage. This matters if you go home after 30 days of nursing home care, recover, and then need care again months later — you would have 100 new days available.

Medicare does not tell you how many days you have left. You have to track it yourself or ask the nursing home's billing office. Write down the day you were admitted and count forward. The nursing home should also tell you in writing how many days Medicare will cover.

What you pay on days 21 through 100

Starting on day 21, you owe a copay for each day you stay. In 2024, that copay is $194 per day. The amount increases each year based on Medicare's cost estimates. Check Medicare.gov or call 1-800-MEDICARE to find the current year's copay amount.

You pay this copay to the nursing home, not to Medicare. The nursing home bills you directly. If you cannot pay, the nursing home may work with you on a payment plan, but they are not required to. Some people use savings, ask family to help, or look into Medicaid to cover these costs.

The copay covers all your care at the facility — room, board, meals, nursing, therapy, and medications. You do not pay extra for individual services. However, if the nursing home charges for something Medicare does not cover (like a private room upgrade or a phone line), you pay that separately.

What Medicare does not cover in a nursing home

Medicare does not pay for custodial care, which is the bulk of what most nursing homes provide. Custodial care includes help with bathing, dressing, toileting, eating, and moving around. It also includes supervision and reminders to take medications or keep appointments. Even if you are in a Medicare-approved nursing home, Medicare will not pay for these services.

Medicare also does not cover private duty nursing (a nurse assigned only to you), most medications you take at home before admission, or care that is not medically necessary. If you need ongoing help with daily living after your 100 days end, you would need to pay out of pocket, use Medicaid, or have a long-term care insurance policy.

Some people confuse Medicare with Medicaid. Medicaid does cover long-term custodial nursing home care, but you must meet income and asset limits that vary by state. If you think you might need long-term care, ask a social worker or your state Medicaid office about your options.

How to find a Medicare-approved nursing home

Not all nursing homes accept Medicare. You can search for Medicare-approved facilities on Medicare.gov using the Care Compare tool. Enter your zip code and the tool shows you nearby facilities, their inspection records, staffing levels, and whether they accept Medicare.

Your hospital discharge planner can also suggest facilities. They often know which homes have beds available and which ones work well with your insurance. If you have a preference, tell the planner early — popular facilities may have a waiting list.

Before you are discharged, confirm in writing that the facility is Medicare-approved and that your doctor has ordered the care. The nursing home should give you a document explaining what Medicare will cover and what you will owe. Read it carefully and ask questions if anything is unclear.

What happens when Medicare coverage ends

On day 101, Medicare stops paying. If you are still in the nursing home and cannot pay the full cost yourself, you have a few options. Some nursing homes will let you stay and work out a payment plan. Others may discharge you if you cannot pay.

If you cannot afford to stay, you can look into Medicaid. Medicaid covers long-term nursing home care in most states, but the rules are strict. You must have very limited income and assets (the limits vary by state). If you own a home, a car, or have savings above the limit, you may not may have access to right away. Some people spend down their assets to meet Medicaid limits, but this is complex and you should talk to an elder law attorney or social worker before doing it.

Another option is to go home with home health care, if your condition allows it. Medicare covers some home health services — nursing, therapy, and medical equipment — if a doctor orders them and you are homebound. This is often cheaper than a nursing home and lets you stay in your own home.

Questions to ask your doctor and the nursing home

Before you are admitted to a nursing home, ask your doctor: "Will Medicare cover this stay? Do I meet the three-day hospital stay requirement? How many days do you think I will need?" Write down the answers.

Ask the nursing home: "Are you Medicare-approved? What will Medicare pay for? What will I owe? When will my coverage end? What happens after day 100?" Ask for this in writing. The nursing home is required to give you a document called the "Notice of Medicare Coverage" that explains what is covered and what you pay.

If you do not understand the coverage explanation, ask the nursing home's social worker or billing office to explain it again. You can also call 1-800-MEDICARE and ask a representative to walk you through it.

Frequently Asked Questions

Does Medicare cover nursing home care for dementia or Alzheimer's disease?

Only if the care is skilled nursing — for example, if you need wound care, physical therapy, or monitoring for a new medical condition. If you need a nursing home only because you cannot remember to take medications or need help with daily tasks, Medicare will not pay. Medicaid may cover this in your state if you meet income and asset limits.

What if I need to stay longer than 100 days?

After day 100, Medicare pays nothing. You would pay the full cost out of pocket, use Medicaid if you may have access to, or use a long-term care insurance policy if you have one. Some nursing homes offer discounted rates for private-pay residents. Ask the facility what options they have.

Can I switch nursing homes and get another 100 days of coverage?

No. The 100 days are per benefit period, not per facility. If you move to a different nursing home while still in the same benefit period, your day count continues. You do not get a fresh 100 days unless you go home for 60 days or longer and start a new benefit period.

Will Medicare cover the cost of my medications in the nursing home?

Yes, medications you take while you are in the nursing home are covered as part of your daily care. You do not pay extra for them. However, medications you took at home before admission are not covered by Medicare — those are your responsibility.

What is the difference between a skilled nursing facility and a nursing home?

A skilled nursing facility is a nursing home that provides skilled nursing care — medical treatment by nurses and therapists. Not all nursing homes are skilled nursing facilities. Some are custodial-only facilities that help with daily living but do not provide medical care. Medicare only covers skilled nursing facilities, and only for skilled care.