Medicare covers some nursing home costs, but not all — and only under specific conditions

Medicare pays for skilled nursing facility (SNF) care, which is short-term medical care you receive after a hospital stay. It does not pay for long-term custodial care — help with daily living like bathing, dressing, and meals — even if you live in a nursing home. The difference matters because it determines what Medicare will cover and for how long.

If you are admitted to a nursing home directly from the hospital for recovery (such as after surgery or a serious illness), Medicare Part A may cover your stay. If you enter a nursing home for ongoing help with daily activities because you can no longer manage at home, Medicare will not pay for that care, and you will need to cover the cost yourself, through Medicaid, or with private insurance.

Key Takeaways

  • Medicare Part A covers up to 100 days of skilled nursing facility care following a hospital stay of at least three consecutive days.
  • You pay nothing for days 1–20, a daily copay (currently $194.50 per day in 2024, though this amount changes yearly) for days 21–100, and all costs after day 100.
  • The nursing home must be Medicare-certified, and a doctor must determine that you need skilled care — not just help with daily living.
  • If you do not improve or your condition stabilizes, Medicare can stop paying even before day 100, so ask your care team regularly about your progress and coverage status.
  • Long-term nursing home care for custodial needs is not covered by Medicare and must be paid through personal funds, Medicaid, or long-term care insurance.

What Medicare Part A covers in a nursing home

Medicare Part A covers skilled nursing care — medical treatment that requires a licensed nurse or therapist. This includes wound care after surgery, intravenous medications, physical therapy to regain mobility, or monitoring of a new medical condition. The care must be ordered by a doctor and must be something you cannot safely receive at home.

The nursing home must be Medicare-certified, meaning it meets federal standards and has agreed to accept Medicare payment. Not all nursing homes are certified. Before admission, ask the facility whether it is Medicare-certified and whether it accepts your specific Medicare plan.

Your hospital stay must have been at least three consecutive days (not counting the day you were discharged) for Medicare to cover nursing home care afterward. If you were hospitalized for only one or two days, Medicare will not pay for the nursing home stay that follows, even if your doctor recommends it.

How much you pay out of pocket

Medicare Part A covers the full cost of the first 20 days of skilled nursing facility care with no copay from you. Starting on day 21, you pay a daily copay amount. In 2024, that copay is $194.50 per day, but this amount is adjusted each year. Check your Medicare Summary Notice or call Medicare at 1-800-MEDICARE to confirm the current copay for the year you need care.

You are responsible for all costs after day 100. If you stay longer than 100 days, you must pay the full daily rate out of pocket, switch to Medicaid (if you meet income and asset limits), or use private long-term care insurance if you have it.

The nursing home may also charge you for items and services that Medicare does not cover, such as phone service, television, or a private room (if you choose one instead of a semi-private room). Ask the facility in writing what additional charges you may owe before you are admitted.

When Medicare stops paying before day 100

Medicare does not automatically pay for the full 100 days. Your care team must document that you are receiving skilled nursing care and making progress toward recovery or improvement. If your condition stops improving or becomes stable, Medicare may determine that you no longer need skilled care and stop payment.

This decision can happen at any point — day 15, day 50, or day 95. When Medicare decides to stop coverage, the nursing home must give you written notice at least two days before the last covered day. You then have the right to appeal that decision if you believe you still need skilled care.

Ask your nurse or doctor regularly: "Am I still receiving skilled care?" and "How is my progress toward recovery?" These conversations help you understand whether your coverage is likely to continue and give you time to plan if it will end soon.

The difference between skilled care and custodial care

This distinction is the reason many people are surprised that Medicare will not pay for their nursing home stay. Skilled care requires the ongoing involvement of a nurse or therapist — wound dressing, medication management, physical therapy, or monitoring of a medical condition. Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, and moving around.

Many nursing home residents need both. Medicare pays only for the skilled portion. If you need custodial care, you pay for that yourself or through Medicaid. Some people receive skilled care for the first few weeks after hospitalization, then transition to custodial care only — at that point, Medicare stops paying and you must cover the cost another way.

A nursing home may offer both types of care in the same facility. The key is what your doctor has ordered and what your medical condition requires. If your doctor orders physical therapy three times a week, that is skilled care. If you need help getting dressed because you cannot bend down, that is custodial care.

How to learn about a nursing home is Medicare-certified

You can search for Medicare-certified nursing homes on the Medicare website at care.cms.gov or by calling 1-800-MEDICARE. The search tool shows you which facilities in your area are certified, their inspection history, and staffing levels.

When you are in the hospital and your doctor recommends a nursing home, ask the hospital discharge planner whether the facility they recommend is Medicare-certified. The discharge planner can also help you understand whether your specific situation qualifies for Medicare coverage.

If you are considering a nursing home before a hospital stay, call ahead and ask directly: "Are you Medicare-certified?" and "Do you accept Medicare Part A?" Some facilities may be certified but may not currently accept new Medicare patients due to staffing or other limits.

What happens if you disagree with Medicare's decision to stop paying

If Medicare or the nursing home tells you that coverage will end, you have the right to appeal. The nursing home must provide you with a written notice that explains why coverage is ending and how to request a review. You have a limited time to appeal — usually a few days — so act quickly if you disagree.

You can request an appeal through the nursing home, by calling Medicare at 1-800-MEDICARE, or by contacting your State Health Insurance information Program (SHIP). SHIP is a free counseling service in every state that helps Medicare beneficiaries understand their coverage and appeal decisions. To find your state's SHIP, visit shiptalk.org or call 1-877-839-2675.

During an appeal, Medicare may send a nurse reviewer to assess whether you still need skilled care. This review is free to you. If the reviewer agrees that you need skilled care, coverage continues. If not, you will owe the nursing home for any days after the coverage end date.

Planning ahead: what to ask before admission

Before you or a family member enters a nursing home, gather this information in writing:

  • Is the facility Medicare-certified?
  • Does it accept Medicare Part A?
  • What is the daily rate for a semi-private room?
  • What charges are not covered by Medicare (phone, TV, private room, etc.)?
  • How does the facility notify you if Medicare coverage will end?
  • What is the facility's process for appealing a coverage denial?
  • Does the facility accept Medicaid if Medicare coverage ends and you need to transition?

Having these answers before admission prevents surprises and helps you plan for costs beyond day 100 if your stay extends that long.

Frequently Asked Questions

Does Medicare pay for nursing home care if I was not in the hospital first?

No. Medicare Part A covers nursing home care only if you were hospitalized for at least three consecutive days when ready before admission. If you enter a nursing home directly from home, Medicare will not pay, regardless of your medical condition or need for care.

What if I run out of money after day 100?

You may be able to transition to Medicaid, which does cover long-term nursing home care. Medicaid has income and asset limits that vary by state. Contact your state Medicaid office or a local legal aid organization to learn whether you may have access to. Some nursing homes have social workers who can help you understand your options.

Can I choose a private room and have Medicare pay for it?

Medicare covers a semi-private room (shared with one other person). If you choose a private room, you pay the difference between the semi-private rate and the private room rate out of pocket. Ask the nursing home for both rates in writing before you decide.

How do I know if I still may have access to for Medicare coverage while I am in the nursing home?

Ask your nurse or doctor at least once a week whether you are still receiving skilled care and making progress. Request a copy of your care plan and any notes about your progress. If you notice that skilled services (therapy, wound care, medications) are decreasing, coverage may end soon. Contact your State Health Insurance information Program if you have questions about your coverage status.

What if the nursing home says I owe money after Medicare stops paying?

Ask the facility for an itemized bill showing the dates Medicare covered and the dates you owe. If you believe Medicare should still be paying, file an appeal before you pay. Do not assume the facility's information is final — you have the right to request a review by Medicare.