Medicare covers skilled nursing care, not custodial care — and the difference determines what you pay

Medicare pays for nursing home stays only when you need skilled nursing care: medical services like wound care, IV therapy, physical therapy after surgery, or monitoring for conditions that require a nurse's judgment. It does not pay for help with daily living — bathing, dressing, meals, or supervision — even if you live in a nursing home. The facility must be Medicare-certified, and you must have been hospitalized for at least three days before admission.

When Medicare does cover your stay, it pays the full cost of the room, meals, nursing care, and therapy for the first 20 days. From day 21 to day 100, you pay a daily coinsurance amount (the facility bills Medicare for the rest). After day 100 in a benefit period, Medicare pays nothing, and you or your family pay the full cost. Most nursing home stays covered by Medicare last two to three weeks, not months.

Key Takeaways

  • Medicare covers skilled nursing care after a hospital stay of at least three days, but only in a Medicare-certified facility.
  • You pay nothing for days 1–20, then a daily coinsurance amount for days 21–100, which varies by year and is set by Medicare.
  • Medicare does not cover custodial care — help with bathing, dressing, or daily supervision — even in a nursing home.
  • Your coverage resets each benefit period (which begins when you enter the hospital), so a new hospital stay can restart your 100-day clock.
  • If you need care beyond 100 days or custodial-only care, Medicaid, private pay, or long-term care insurance may cover the cost.

What Medicare covers and what it does not

Medicare Part A covers skilled nursing facility (SNF) care when a doctor determines you need daily skilled nursing or therapy services. This includes wound dressing, catheter care, IV medications, physical or occupational therapy after a stroke or surgery, and speech therapy. The facility must provide these services under the supervision of a registered nurse or licensed therapist.

Medicare does not cover custodial care — the help most people think of when they picture a nursing home. This includes bathing, dressing, grooming, toileting, eating, and supervision or monitoring. If you need only custodial care, even if you live in a nursing home, Medicare will not pay. Medicaid covers custodial care in nursing homes for people who meet income and asset limits, but Medicare does not.

The facility itself must be Medicare-certified. Not all nursing homes are. Before admission, ask the nursing home directly whether it is Medicare-certified, or search the Medicare Care Compare tool on Medicare.gov to confirm.

The three-day hospital stay requirement

To be covered by Medicare for a nursing home stay, you must have been an inpatient in a hospital for at least three consecutive days when ready before admission to the nursing home. The three days must be calendar days, and the day you are discharged from the hospital does not count toward the three days.

This rule trips up many people. If you go to the emergency room or are admitted for observation (not as an inpatient), those days do not count. Ask the hospital directly whether you are being admitted as an inpatient or held for observation — the label matters for Medicare coverage. If you are unsure, request a written notice explaining your status before you leave the hospital.

The nursing home admission must happen within a short window after discharge — usually within 30 days, though some exceptions exist. If you go home first and then enter a nursing home weeks later, the hospital stay no longer qualifies you for Medicare coverage.

How much you pay: days 1–20 and days 21–100

For the first 20 days of a covered nursing home stay, Medicare pays 100 percent of the cost. You pay nothing out of pocket for the room, meals, nursing care, or therapy.

From day 21 through day 100, you pay a daily coinsurance amount set by Medicare each year. Medicare pays the rest. This coinsurance amount changes annually and is different from your hospital deductible. For 2024, the daily coinsurance for skilled nursing facility care is $200 per day, but this figure changes each January. Check Medicare.gov or call 1-800-MEDICARE to confirm the current amount before your stay begins.

After day 100 in a benefit period, Medicare coverage ends completely. You or your family pay the full cost of the nursing home, which varies widely by location and facility type but often ranges from $100 to $300 per day or more. At that point, Medicaid (if you meet the income and asset limits) or private pay becomes the funding source.

Benefit periods and how they reset

Your Medicare coverage for nursing home care is tied to a benefit period, which begins the day you enter the hospital. A benefit period ends when you have not received inpatient hospital care or skilled nursing facility care for 60 consecutive days. Once a benefit period ends, a new one begins with your next hospital admission, and your 100-day nursing home clock resets.

This means if you are discharged from a nursing home after 30 days, go home for 60 days or more, and then are hospitalized again, you get a fresh 100-day benefit period for a new nursing home stay. However, if you return to the nursing home within 60 days of leaving, you are still in the same benefit period, and your remaining days count down from where you left off.

Understanding this timing matters for planning. If you are approaching day 100 and still need care, talk to the social worker at the nursing home about Medicaid coverage, private pay options, or whether a brief discharge and readmission might reset your benefit period.

When Medicaid takes over after Medicare ends

If you need nursing home care beyond 100 days or need only custodial care, Medicaid may pay if you meet your state's income and asset limits. Medicaid covers both skilled nursing care and custodial care, making it the primary payer for long-term nursing home stays.

However, Medicaid has strict financial limits. Most states allow you to keep a small amount of assets (often $2,000 to $3,000 for an individual) and a modest monthly income. If you have more, you must spend down your savings to Medicaid limits before the program begins paying. Some people plan for this by using a Medicaid-planning attorney, but the rules vary significantly by state.

To explore Medicaid coverage, contact your state Medicaid office or the nursing home's social worker. They can tell you whether you meet your state's limits and what paperwork is needed.

Long-term care insurance and private pay

If you have a long-term care insurance policy, it may cover nursing home costs after Medicare ends or for custodial-only care. The amount and duration of coverage depend on your specific policy. Review your policy documents or call your insurance company to understand what your plan covers and what daily benefit amount it provides.

Many people pay for nursing home care privately — out of savings, retirement accounts, or family contributions. The cost varies by location and facility. Urban areas and facilities with more amenities tend to be more expensive. Some nursing homes offer financial counseling to help families understand payment options and plan for longer stays.

If you are considering a nursing home stay, ask the facility's business office for a detailed cost estimate and a list of what Medicare covers versus what you would pay out of pocket.

Frequently Asked Questions

Does Medicare cover nursing home care if I did not have a hospital stay first?

No. Medicare covers nursing home care only after a hospital inpatient stay of at least three consecutive days. If you go directly from home or another setting to a nursing home, Medicare will not pay for skilled nursing facility care. Medicaid may cover custodial care if you meet income and asset limits, but you would need to explore that separately.

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

Once you reach day 100 of a benefit period, Medicare stops paying. At that point, you, your family, or Medicaid (if you may have access to) must pay the nursing home bill. Talk to the facility's social worker about your options — they can help you understand Medicaid, discuss private pay arrangements, or explore whether discharge and readmission might reset your benefit period.

Can I use Medicare to pay for a nursing home if I only need help with daily living?

No. Medicare covers only skilled nursing care and therapy, not custodial care like bathing, dressing, or supervision. If you need only help with daily living, Medicaid is the primary payer for nursing home care, provided you meet your state's income and asset limits.

Does the three-day hospital stay have to be for the same condition I need nursing home care for?

No. The hospital stay does not have to be related to the reason you need nursing home care. Any three-day inpatient hospital stay qualifies you, as long as the nursing home admission happens within the required timeframe afterward.

If I leave the nursing home and come back within 60 days, do I lose my remaining Medicare days?

Yes. If you leave the nursing home and return within 60 days, you are still in the same benefit period, and your remaining days count down from where you left off. If you stay out for 60 or more consecutive days without inpatient hospital or skilled nursing care, a new benefit period begins with your next hospital admission, and you get a fresh 100 days.