Medicare covers skilled nursing care, but only under specific conditions and only for a limited time
Medicare pays for nursing home stays, but not for all nursing home care and not for as long as you might need. The program covers skilled nursing facility (SNF) care — which means medical care that requires a nurse or therapist — but only if you meet strict requirements. Medicare will not pay for custodial care, which is help with daily activities like bathing or dressing when no skilled medical care is involved.
The amount Medicare pays depends on how many days you have been in the facility. For the first 20 days, Medicare covers the full cost of your room, meals, and care. From day 21 through day 100, you pay a daily coinsurance amount — a set dollar figure that changes each year — and Medicare covers the rest. After day 100 in the same benefit period, Medicare pays nothing, and you are responsible for all costs.
Key Takeaways
- Medicare covers skilled nursing care only after a hospital stay of at least three days, and only if you are admitted to the nursing home within 30 days of leaving the hospital.
- Medicare pays the full cost for days 1 through 20, then you pay a daily coinsurance amount (which varies by year) for days 21 through 100.
- After day 100 in a benefit period, Medicare stops paying entirely, and you must cover all costs yourself or use other insurance.
- The nursing home must be a Medicare-certified skilled nursing facility, not just any nursing home.
- Your doctor must order the skilled care, and a Medicare reviewer must determine it is medically necessary.
The three-day hospital stay requirement
Medicare will only pay for nursing home care if you spent at least three consecutive days in a hospital when ready before admission. The three days must be for inpatient care — not observation or outpatient services — and they must be in a row. If you are discharged after two days, Medicare will not cover your nursing home stay, even if your doctor says you need one.
You must also be admitted to the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home later, that stay will not be covered by Medicare. The 30-day window is strict, so timing matters if you are considering a nursing home after discharge.
How much you pay out of pocket
Your out-of-pocket cost depends on which day of your stay you are on. Days 1 through 20 are fully covered by Medicare at no cost to you. Starting on day 21, you pay a daily coinsurance amount. In 2024, that amount is $194.50 per day, but this figure changes each year based on Medicare's cost calculations. Check with your nursing home or Medicare directly for the current year's amount.
If you stay past day 100, you pay the full cost of the facility with no Medicare help. Many people use Medicaid or private long-term care insurance to cover costs after Medicare stops. Some nursing homes offer payment plans or sliding scale fees based on income. Ask the facility's business office what options exist if your stay extends beyond 100 days.
What counts as skilled nursing care
Medicare only pays for care that requires the skills of a nurse, therapist, or other medical professional. Examples include wound care after surgery, intravenous (IV) medication, physical therapy after a stroke, or monitoring for complications after a heart attack. If you need help with bathing, dressing, or meals but no medical care, that is custodial care, and Medicare will not pay for it.
The line between skilled and custodial care can be unclear. A nurse helping you with medication is skilled care. A nurse helping you bathe because you cannot do it yourself is often custodial care, even though a nurse is doing it. Medicare reviewers make this information, and they may decide partway through your stay that your care is no longer skilled. If that happens, Medicare stops paying, and you must cover the cost or leave the facility.
Medicare-certified facilities only
The nursing home must be Medicare-certified to receive Medicare payment. Not all nursing homes are certified. Before admission, ask the facility whether it is Medicare-certified and whether it accepts Medicare. You can also search for certified facilities on Medicare.gov using the Nursing Home Compare tool, which lists every certified facility in the country, shows which ones accept Medicare, and displays inspection records and staffing levels.
If you are admitted to a facility that is not Medicare-certified, Medicare will not pay, even if you meet all other requirements. Some facilities are Medicaid-certified but not Medicare-certified, or vice versa. Always confirm certification status before you or a family member is admitted.
What happens when Medicare coverage ends
When Medicare stops paying — either because you have used 100 days or because reviewers decide your care is no longer skilled — you have options. If you are a Medicaid recipient or become one, Medicaid may cover long-term custodial care in a nursing home. Medicaid rules vary by state, and some states cover nursing home care more generously than others. You can contact your state Medicaid office to learn what is available.
If you have private long-term care insurance, check your policy to see whether it covers nursing home stays and what the daily benefit is. Some policies have waiting periods or require you to pay out of pocket for a certain number of days before coverage begins. If you have neither Medicaid nor private insurance, you will need to pay the facility directly, arrange a payment plan, or explore whether the facility offers financial information or reduced rates for uninsured residents.
How to find out what Medicare will pay for your specific situation
Your hospital discharge planner or social worker can tell you whether your hospital stay qualifies and whether Medicare is likely to cover nursing home care. They can also help you find a Medicare-certified facility and start the admission process. If you are unsure, call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask about your specific situation — they can tell you whether the three-day requirement was met and roughly how many days Medicare might cover.
Once you are in the nursing home, the facility's business office will track your days and tell you when you are approaching day 100. They will also notify you if a Medicare reviewer determines that your care is no longer skilled. Do not wait until day 100 to plan for what comes next — start exploring Medicaid, insurance, or payment options well before coverage ends.
Frequently Asked Questions
Does Medicare cover nursing home care without a hospital stay first?
No. Medicare only covers nursing home care if you spent at least three consecutive days in a hospital as an inpatient when ready before admission. If you go directly from home to a nursing home, Medicare will not pay, even if your doctor recommends it.
What if I am in the nursing home on day 100 and still need care?
Medicare stops paying after day 100 in a benefit period. You must then pay out of pocket, use Medicaid if you are may be able to access, or use private insurance. Talk to the nursing home's business office about payment options and whether they can help you explore Medicaid coverage.
Can I use my Medigap or Medicare Advantage plan to cover the daily coinsurance in the nursing home?
Some Medigap plans cover part or all of the daily coinsurance amount for days 21 through 100. Medicare Advantage plans vary widely. Check your plan documents or call your insurance company to see what nursing home costs are covered.
How do I know if a nursing home is Medicare-certified?
You can search Medicare.gov's Nursing Home Compare tool by name, city, or zip code. The tool shows which facilities are Medicare-certified, which accept Medicare, and displays inspection records and staffing information. You can also call the facility directly and ask.
What if Medicare says my care is no longer skilled partway through my stay?
Medicare will notify you in writing if a reviewer decides your care has become custodial. You have the right to appeal this decision. Contact your state's Long-Term Care Ombudsman (a free advocate for nursing home residents) or call Medicare to learn how to file an appeal.