Medicare covers nursing home care only after a hospital stay, and only for skilled nursing, not custodial care
Medicare will pay for a nursing home stay, but only under specific conditions. You must have been admitted to a hospital for at least three consecutive days (not counting the day you leave), and you must move to a nursing home within 30 days of leaving the hospital. The nursing home must be Medicare-certified. Even then, Medicare only pays for skilled nursing care — medical services like wound care, physical therapy, or medication management — not for help with daily activities like bathing or dressing.
If you need a nursing home but have not had a may have access to hospital stay, Medicare does not pay. If you need only custodial care (help with activities of daily living), Medicare does not pay, even with a hospital stay. Understanding this distinction matters because it shapes how long Medicare will cover your stay and what happens when that coverage ends.
Key Takeaways
- Medicare covers nursing home care only after a hospital stay of at least three consecutive days, and only within 30 days of discharge.
- Medicare pays only for skilled nursing care — medical services like wound dressing or physical therapy — not for custodial care like bathing or dressing.
- Medicare covers the first 20 days at 100 percent, days 21 through 100 with a daily copay (amount varies yearly), and nothing after day 100 in a benefit period.
- If you stay longer than 100 days or need only custodial care, Medicaid, private pay, or long-term care insurance may cover the cost.
The three-day hospital stay requirement
The trigger for Medicare nursing home coverage is a hospital admission. You must spend at least three consecutive midnights in the hospital as an inpatient. A same-day surgery or observation stay does not count, even if you spend 23 hours in the hospital. The three days must be consecutive — if you are discharged and readmitted, the clock starts over.
After you leave the hospital, you have 30 days to enter a Medicare-certified nursing home. If you wait longer than 30 days, you lose the connection to that hospital stay, and Medicare will not pay for the nursing home care. The nursing home must accept Medicare and must be certified to provide the level of care you need.
Skilled nursing versus custodial care
Medicare distinguishes between two types of nursing home care. Skilled nursing care is medical care that requires a nurse or therapist — wound dressing, catheter care, intravenous medication, physical therapy, occupational therapy, or speech therapy. Custodial care is help with daily living — bathing, dressing, toileting, eating, and transferring in and out of bed.
Medicare pays only for skilled care. If a doctor determines you need skilled care and you meet the hospital-stay requirement, Medicare will cover it. If you need only custodial care, or if your skilled care needs end, Medicare stops paying. Many people enter a nursing home thinking Medicare will cover their stay, only to learn that their care is classified as custodial and they must pay out of pocket or turn to Medicaid.
How long Medicare pays and what it costs
Medicare covers up to 100 days in a nursing home per benefit period (the benefit period runs from October 1 to September 30). The coverage breaks into three tiers:
| Days | What Medicare Pays | What You Pay |
|---|---|---|
| 1–20 | 100 percent of the cost | Nothing |
| 21–100 | All costs except a daily copay | Daily copay (amount set yearly by Medicare) |
| 101 and beyond | Nothing | Full cost of care |
The daily copay for days 21 through 100 changes each year. For 2024, it is $194.50 per day, but this amount increases annually. After day 100 in a benefit period, Medicare pays nothing, and you must cover the full cost yourself or use another source of payment.
When Medicare coverage ends
Medicare stops paying for your nursing home stay when one of three things happens: you have used all 100 days in your benefit period, your doctor determines you no longer need skilled nursing care, or you are discharged from the nursing home. If your skilled care needs end before day 100, Medicare stops paying when ready, even if you remain in the nursing home.
The nursing home must notify you in writing when Medicare coverage is ending. You have the right to appeal if you disagree with the decision that you no longer need skilled care. If you appeal and lose, you become responsible for all costs from the date the nursing home says your skilled care ended, not from the date the appeal is decided.
What happens after Medicare coverage ends
If you need to stay in the nursing home after Medicare stops paying, you have several options. You can pay out of pocket if you have the resources. You can turn to Medicaid, which covers long-term nursing home care for people with limited income and assets, though Medicaid rules and coverage vary by state. You can use long-term care insurance if you have a policy. Or you can leave the nursing home and arrange care elsewhere.
Medicaid is the largest payer of nursing home care in the United States, but it requires you to spend down your savings to a certain level before it begins paying. The income and asset limits vary by state. If you think you may need Medicaid, ask the nursing home's social worker or your state Medicaid office about the rules in your state and how to plan ahead.
How to know if a nursing home is Medicare-certified
Before you enter a nursing home, confirm that it is Medicare-certified. You can search for certified facilities on Medicare.gov using the Care Compare tool, or call Medicare at 1-800-MEDICARE. The nursing home itself can also tell you whether it is certified. If it is not certified, Medicare will not pay for your stay, even if you meet all other requirements.
When you are discharged from the hospital, the hospital discharge planner can help you find a Medicare-certified nursing home and arrange your transfer. If you are choosing a nursing home on your own, ask the facility directly whether it is Medicare-certified and whether it has an available bed for your level of care.
Frequently Asked Questions
Does Medicare pay for nursing home care if I did not have a hospital stay?
No. Medicare nursing home coverage requires a hospital stay of at least three consecutive days. If you enter a nursing home directly from home or from an outpatient setting, Medicare does not pay. Medicaid or private pay would be your options.
What if I need help with bathing and dressing but not medical care?
Medicare does not pay for custodial care. If your only need is help with daily activities, Medicare coverage does not explore. You would need to pay out of pocket, use Medicaid (if you meet income and asset limits), or arrange care at home instead.
Can I appeal if Medicare says I no longer need skilled care?
Yes. You have the right to appeal the decision. Contact the nursing home's social worker or call Medicare at 1-800-MEDICARE to request an appeal. If you appeal, you may continue to receive Medicare-covered care while the appeal is being reviewed, though you may owe the cost if the appeal is denied.
What if I run out of Medicare coverage before I am ready to leave?
Talk to the nursing home's social worker about your options. Medicaid may cover ongoing care if you meet your state's income and asset limits. Some facilities offer private-pay rates for residents who have exhausted Medicare. Long-term care insurance, if you have it, may also help cover the cost.
How do I know how many days I have left in my Medicare benefit period?
Ask the nursing home's billing department or social worker. They track your days and can tell you how many you have used and how many remain. You can also call Medicare at 1-800-MEDICARE to check your benefit period status.