Medicare covers some nursing home costs, but only under specific conditions and only for a limited time
Medicare pays for skilled nursing care — nursing and therapy services you need after a hospital stay — but not for custodial care, which is help with daily living like bathing, dressing, and meals. The difference matters because it determines whether Medicare pays anything at all. If you enter a nursing home directly without a hospital stay first, Medicare will not pay. If you do may have access to, Medicare covers the full cost of the first 20 days, then requires you to pay a daily amount (called a coinsurance) for days 21 through 100. After 100 days in the same benefit period, you pay all costs yourself.
The nursing home must be Medicare-certified for Medicare to pay. Not all nursing homes are. You can check whether a specific home accepts Medicare by calling it directly or searching the Medicare Care Compare tool on Medicare.gov. Your hospital discharge planner can also tell you which homes in your area are certified.
Key Takeaways
- Medicare only pays for skilled nursing care after a hospital stay of at least three days, not for custodial care or nursing home stays that begin without hospitalization.
- Medicare covers days 1 through 20 at no cost to you, then you pay a daily coinsurance amount for days 21 through 100 in the same benefit period.
- After 100 days in one benefit period, Medicare stops paying and you become responsible for the full nursing home bill.
- The nursing home must be Medicare-certified, and you must receive skilled nursing or rehabilitation services, not just personal care information.
- Your doctor must order the nursing home stay, and you must be admitted within 30 days of leaving the hospital for Medicare to cover it.
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 entering the nursing home. The three days must be for inpatient care — not observation or outpatient services. This is one of the most common reasons Medicare denies nursing home coverage: a person goes to the emergency room, is admitted for observation overnight, and then is sent to a nursing home thinking Medicare will pay. It will not, because observation does not count as an inpatient hospital stay.
You must be admitted to the nursing home within 30 days of leaving the hospital. If you go home first and then enter a nursing home weeks later, Medicare will not cover it. Ask your hospital discharge planner to confirm you had three days of inpatient care before you leave the hospital, because this determines everything that follows.
What "skilled nursing care" means and what Medicare will not pay for
Medicare pays only for care that requires a nurse or therapist — wound care, injections, physical therapy, occupational therapy, or speech therapy. It does not pay for help with bathing, dressing, toileting, eating, or other daily activities, even if a nursing home employee provides that help. It does not pay for room and board, meals, or laundry. It does not pay for custodial care, which is the main reason most people move to nursing homes.
If you need only custodial care — you can manage your medications and medical needs but need help with daily living — Medicare will not pay for the nursing home at all. Medicaid may, depending on your state and your income, but that is a separate program with different rules. Some people have both Medicare and Medicaid (called "dual may be able to access"), and in those cases Medicaid may cover the custodial portion after Medicare stops paying.
How much you pay: the first 20 days and days 21 through 100
For days 1 through 20 of a covered nursing home stay, you pay nothing. Medicare pays the full approved amount to the nursing home. You may still owe any costs the nursing home charges above what Medicare approves, depending on whether the home is in-network or out-of-network and your specific plan, so ask the nursing home about this before admission.
Starting on day 21, you pay a daily coinsurance amount. For 2024, this amount is $194.50 per day, though it changes each year. The nursing home bills you directly for this amount. You are responsible for paying it even if you cannot afford it — Medicare does not waive this cost based on income. After day 100 in the same benefit period, you pay the entire nursing home bill yourself. A benefit period begins the day you enter the hospital and ends 60 days after you leave the hospital or nursing home, whichever is later.
When Medicare coverage ends
Medicare coverage ends when any of these happens: you have been in the nursing home for 100 days in the same benefit period; your doctor determines you no longer need skilled nursing care; you are discharged; or you move to a different facility that is not Medicare-certified. If your doctor says you no longer need skilled care but you want to stay in the nursing home for custodial care, you can stay, but you pay the full cost yourself.
The nursing home must tell you in writing when Medicare coverage will end. This notice, called a Notice of Non-Coverage, must be given to you before coverage stops. If you disagree that you no longer need skilled care, you have the right to appeal. You have until midnight of the day you receive the notice to request an appeal, or you lose your right to one.
How to learn about a nursing home is Medicare-certified
Before you choose a nursing home, confirm it is Medicare-certified. You can search by name or location on Medicare Care Compare at Medicare.gov. The tool shows which services each home offers, staffing levels, inspection results, and whether it accepts Medicare. You can also call the nursing home directly and ask whether it is Medicare-certified and whether it has an available bed in a Medicare-certified unit.
Not all units in a nursing home are necessarily certified. Some homes have both certified and non-certified beds. Make sure the bed you are assigned to is in a Medicare-certified unit, because Medicare will not pay if it is not. Your hospital discharge planner can help you find certified homes in your area and can often arrange the transfer directly from the hospital.
What happens after Medicare stops paying
When Medicare coverage ends, you have several options. You can stay in the nursing home and pay out of pocket. You can move to a different facility. You can go home with home health care, which Medicare may cover if your doctor orders it and you meet the requirements. You can move to an assisted living facility, which Medicare does not cover but may be less expensive than a nursing home.
If you cannot afford to pay for the nursing home yourself, ask the social worker at the nursing home about Medicaid coverage. Medicaid rules vary by state, but many states will cover nursing home care for people with low income and limited assets. Some people spend down their savings to become Medicaid-may be able to access, though this is a complex decision that may benefit from information from an elder law attorney or financial advisor.
Questions to ask your doctor and the nursing home
Before you are discharged from the hospital to a nursing home, ask your doctor: "Will Medicare cover my nursing home stay?" and "How long do you expect I will need skilled nursing care?" Ask the nursing home: "Are you Medicare-certified?" "What is your daily coinsurance rate?" "What costs will I owe beyond what Medicare pays?" and "When will you notify me if Medicare coverage is ending?"
If you receive a Notice of Non-Coverage and disagree with it, ask the nursing home social worker to explain why your doctor believes you no longer need skilled care. You can also ask to speak with your doctor directly. If you still disagree, you have the right to request an appeal through Medicare. The nursing home should provide you with information on how to appeal.
Frequently Asked Questions
Does Medicare cover nursing home care if I did not spend three days in the hospital first?
No. Medicare requires a three-day inpatient hospital stay when ready before the nursing home stay. Observation stays do not count. If you go directly to a nursing home from home or from an emergency room, Medicare will not pay for the nursing home care.
What is the difference between Medicare and Medicaid for nursing homes?
Medicare is federal health insurance for people 65 and older and covers skilled nursing care after a hospital stay for up to 100 days per benefit period. Medicaid is a joint federal-state program for low-income people and covers custodial care in nursing homes with no hospital stay requirement, but may be able to access and coverage rules vary by state.
Can I appeal if Medicare says I no longer need skilled nursing care?
Yes. You must request an appeal by midnight of the day you receive the Notice of Non-Coverage. The appeal goes through a peer review process. You can ask your doctor to provide information supporting your need for continued skilled care, and you have the right to speak with a reviewer before a final decision is made.
What happens to my Medicare coverage if I move to a different nursing home?
If you move to another Medicare-certified nursing home, your coverage continues in the new facility and your day count continues from where it left off. If you move to a facility that is not Medicare-certified, Medicare coverage stops when ready.
Will Medicare pay for a nursing home if I need only help with bathing and dressing?
No. Medicare only pays for skilled nursing care — services that require a nurse or therapist. Help with bathing, dressing, and other daily activities is custodial care, which Medicare does not cover. Medicaid may cover it in your state if you meet income and asset limits.