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

Medicare will pay for a nursing home stay only if you are admitted directly from a hospital stay of at least three consecutive days, and only if a doctor orders the care as medically necessary. This is called skilled nursing facility (SNF) care. Medicare does not pay for custodial care — help with daily activities like bathing, dressing, or meals — unless it is part of a skilled nursing plan. The nursing home must be Medicare-certified, and your doctor must document that you need daily skilled nursing or rehabilitation services that cannot be provided at home.

The timing matters. You must enter the nursing home within 30 days of leaving the hospital. If you wait longer, Medicare will not cover it, and you will be responsible for the full cost. Many people do not realize this important date exists, so it is important to discuss the plan with your hospital discharge planner before you leave.

Key Takeaways

  • Medicare covers nursing home care only after a hospital stay of at least three consecutive days, and only for skilled nursing or rehabilitation — not for help with daily living alone.
  • You must enter a Medicare-certified nursing home within 30 days of hospital discharge, or Medicare will not cover any of the cost.
  • Medicare pays the full cost for days 1 through 20, but you pay a daily coinsurance amount (which varies yearly) for days 21 through 100; after day 100, you pay all costs.
  • Your hospital discharge planner can help you find a Medicare-certified facility and confirm your may be able to access before you are discharged.
  • If you do not meet the three-day hospital stay requirement, you may still pay out of pocket or explore Medicaid options, depending on your state and income.

The three-day hospital stay requirement

Medicare's rule is strict: you must spend at least three consecutive days as an inpatient in a hospital before Medicare will cover a nursing home stay. Observation stays do not count — only days when you are formally admitted as an inpatient. This distinction matters because many people spend time in a hospital observation unit and assume they have met the requirement when they have not.

If you are unsure whether your hospital days count, ask the hospital billing department or your discharge planner directly. They can tell you the exact number of inpatient days on your record. If you have only one or two days, Medicare will not cover the nursing home, even if your doctor says you need it.

Some people have successfully appealed when they believe the hospital admission status was wrong. You can file an appeal through Medicare, but this takes time and is not may provide to change the decision. It is better to clarify the requirement before discharge so you can plan accordingly.

What Medicare pays and what you pay

Medicare Part A covers nursing home care on a sliding scale. For days 1 through 20, Medicare pays 100 percent of the cost at a Medicare-certified facility. You pay nothing during this period. Starting on day 21, you pay a daily coinsurance amount — the amount changes each year, so check your current Medicare materials or call Medicare at 1-800-MEDICARE to find out this year's figure. Medicare covers the rest.

This coinsurance continues through day 100 of your stay. After day 100, Medicare stops paying entirely, and you are responsible for the full daily cost of the nursing home. The daily rate at a nursing home varies widely by location and facility type, ranging from several hundred to over a thousand dollars per day in many areas.

Your nursing home will tell you the daily rate and explain your costs before or shortly after admission. Ask for this in writing so you have a clear record. If you have a Medigap or Medicare Advantage plan, check your policy to see whether it covers any of the coinsurance or costs after day 100.

How to find a Medicare-certified nursing home

Your hospital discharge planner is your best starting point. They know which facilities in your area accept Medicare, have beds available, and match your medical needs. They can also verify that a facility is Medicare-certified before you are discharged. Do not wait until after you leave the hospital to start this search — discharge planners work fastest when you give them a few days' notice.

You can also search Medicare's Nursing Home Compare tool online at Medicare.gov. This tool lists every Medicare-certified facility in the country, shows inspection results, staffing levels, and ratings. It does not tell you which facilities have beds available right now, so you will still need to call facilities directly to ask about openings.

When you call a nursing home, ask three things: Do you accept Medicare? Do you have a bed available in the next few days? Can you accept patients who need the type of care I need (for example, wound care, physical therapy, or dialysis)? Some facilities specialize in certain types of rehabilitation and may not be a good fit for your situation.

The discharge planning process

Before you leave the hospital, the discharge planner will meet with you and your family to discuss your options. They will ask where you want to go, whether you have family support at home, and what level of care you need. Be honest about your situation — if you live alone and cannot manage stairs or cooking, a nursing home may be the right choice even if you are hesitant about it.

The discharge planner will contact nursing homes on your behalf and arrange admission. They will also send your medical records to the facility so the nursing home knows your diagnosis, medications, and care plan. This handoff usually takes one to three days, so you may stay in the hospital a bit longer while a bed is arranged.

Ask the discharge planner for a written summary of your care plan and a list of the facilities they contacted. Keep this for your records. If you are unhappy with the options offered, you can request a different facility, though availability may limit your choices.

What happens if you do not meet the three-day requirement

If your hospital stay was only one or two days, Medicare will not cover nursing home care. You have a few options. You can pay out of pocket if you have savings. You can ask the nursing home about a payment plan. Some facilities offer reduced rates for private-pay patients, though this is not may provide.

You may also be able to use Medicaid to cover nursing home costs if your income and assets fall below your state's limits. Medicaid rules vary significantly by state — some states cover nursing home care more generously than others. Contact your state Medicaid office or a local Area Agency on Aging to learn what is available where you live.

Another option is to go home with home health services if your doctor approves. Medicare may cover skilled nursing or physical therapy at home for a limited time, which could help you recover enough to avoid a nursing home altogether. Your discharge planner can discuss this possibility with you.

Appealing a Medicare nursing home decision

If Medicare denies coverage for your nursing home stay or ends coverage before you think it should, you have the right to appeal. You will receive a notice explaining the reason for the denial. Read it carefully — it will tell you how to request an appeal and the important date for doing so.

For most appeals, you start by asking your nursing home or doctor to request a review. This is called a peer-to-peer review. A Medicare medical reviewer will look at your case and decide whether the denial was correct. This process usually takes a few days to a week.

If you disagree with the review decision, you can file a formal appeal with Medicare. This is more complex and may benefit from help — your state's Patient Advocate Foundation or a legal aid office can sometimes information. Keep all your medical records and hospital discharge paperwork organized while you appeal.

Frequently Asked Questions

Does Medicare cover nursing home care if I was never in the hospital?

No. Medicare requires a hospital stay of at least three consecutive days before it will cover nursing home care. If you go directly from home to a nursing home, Medicare will not pay for it, even if your doctor says you need skilled nursing care. You would need to pay out of pocket or explore Medicaid options.

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

A skilled nursing facility (SNF) is a nursing home that is certified by Medicare and provides skilled nursing care — wound care, medication management, physical therapy, and similar services ordered by a doctor. Not all nursing homes are skilled nursing facilities. Medicare only covers care at a Medicare-certified SNF, not at other types of long-term care facilities.

Can I choose any nursing home I want, or does Medicare limit my options?

You can choose any Medicare-certified nursing home that has a bed available and will accept you. Medicare does not restrict your choice to certain facilities. However, availability is often limited, especially if you need admission quickly. Your discharge planner can help you find options, but the final choice is yours.

What happens to my Medicare coverage after I leave the nursing home?

Your Medicare coverage continues as normal. Part A covers hospital and skilled nursing care; Part B covers doctor visits and outpatient services. If you receive home health services after you leave the nursing home, Medicare may cover those for a limited time if your doctor orders them and you are homebound.

Can I appeal if Medicare says I do not need skilled nursing care anymore?

Yes. If you believe Medicare ended your coverage too early, you can request a peer-to-peer review or file a formal appeal. You have the right to continue receiving care while your appeal is being reviewed, though you may be responsible for costs if the appeal is denied. Ask your nursing home or doctor to help you start the appeal process.