Medicare covers some nursing home costs, but only under specific conditions and for a limited time
Medicare will pay for skilled nursing care in a nursing home, but only if you meet strict requirements: you must have been hospitalized for at least three consecutive days, admitted to the nursing home within 30 days of leaving the hospital, and need daily skilled care (like wound care, physical therapy, or medication management) that cannot be done at home. Even when you meet these conditions, Medicare pays in full for days 1–20, then requires you to pay a daily copay for days 21–100. After day 100 in the same benefit period, Medicare stops paying entirely.
Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting when that is the only care you need. It also does not cover long-term residential care in a nursing home. If you need a nursing home for reasons other than recovery from a hospital stay, or if you need care longer than 100 days, you will need to pay out of pocket, use Medicaid (a different program), or rely on long-term care insurance if you have it.
Key Takeaways
- Medicare covers skilled nursing care only after a hospital stay of at least three consecutive days, and only if you are admitted to the nursing home within 30 days.
- Medicare pays the full cost for the first 20 days, then you pay a copay (the amount changes each year) for days 21 through 100.
- After 100 days in the same benefit period, Medicare coverage ends and you must pay all costs yourself.
- If you need a nursing home without a may have access to hospital stay, or for custodial care only, Medicare will not pay — Medicaid or private payment may be your only options.
The three-day hospital stay requirement
The hospital stay must be for acute care — treatment of a sudden illness or injury — and must last at least three consecutive days. The day you are discharged does not count toward the three days. So if you are admitted on a Monday and discharged on Thursday, that counts as three days (Monday, Tuesday, Wednesday). Observation stays, where you are monitored but not formally admitted as an inpatient, do not count, even if you spend three calendar days in the hospital.
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, that later stay will not may have access to for Medicare coverage. Some people spend a few days at home or in rehabilitation before entering the nursing home and still meet the requirement, as long as the nursing home admission happens within the 30-day window.
What "skilled nursing care" means to Medicare
Skilled nursing care is medical or therapeutic care that requires a nurse or therapist to perform it safely. Examples include wound dressing changes, intravenous medication, catheter care, physical therapy after surgery or stroke, occupational therapy to regain function, and speech therapy. The care must be ordered by a doctor and documented as medically necessary for your recovery.
Custodial care — which includes bathing, dressing, grooming, toileting, and eating information — is not skilled care, even if a nurse provides it. If you need only custodial care, Medicare will not pay for the nursing home stay. Many people enter a nursing home needing both skilled care (like physical therapy) and custodial care (like help bathing). Medicare covers the skilled portion, but you or another payer must cover the custodial portion.
How much Medicare pays and for how long
Medicare covers 100 percent of the cost for days 1 through 20 of a may have access to nursing home stay. You pay nothing during this period, as long as the nursing home is Medicare-certified and you meet all the requirements.
For days 21 through 100, you pay a daily copay amount. This copay changes each year — in 2024 it was $200 per day, but you should confirm the current amount with your nursing home or Medicare. Medicare pays the rest of the bill. After day 100 in the same benefit period (which runs from October 1 to September 30), Medicare stops paying and you are responsible for all costs.
The 100-day limit resets each benefit period. If you leave the nursing home and return to the hospital for at least three days, then re-enter the nursing home, you may get a new 100-day benefit period. However, if you straightforward leave the nursing home and come back without a may have access to hospital stay in between, your days do not reset.
When Medicare does not pay for nursing home care
Medicare will not pay if you do not have a may have access to hospital stay. If your doctor sends you directly to a nursing home from home or from an outpatient clinic, Medicare coverage is not available. Some people mistakenly believe that Medicare covers nursing home care for any reason, but it does not.
Medicare also will not pay for custodial care alone, even after a hospital stay. If you recover from your acute illness or injury but still need help with daily living activities, that is custodial care and is not covered. Additionally, Medicare does not cover care in assisted living facilities, board-and-care homes, or other residential settings that are not licensed nursing homes.
If you need long-term care beyond 100 days, or if you need a nursing home without a hospital stay, you will need to explore other options: Medicaid (which does cover long-term custodial care if you meet income and asset limits), private payment, long-term care insurance, or Veterans benefits if you are a veteran.
How to know if a nursing home accepts Medicare
Not all nursing homes accept Medicare. Before you or a family member is discharged from the hospital, ask the hospital discharge planner which nursing homes in your area are Medicare-certified. The discharge planner's job is to help arrange your next care and can tell you which facilities will accept your Medicare coverage.
You can also search for Medicare-certified nursing homes on the Medicare website (Medicare.gov) using their Nursing Home Compare tool. This tool shows which homes are certified, their inspection history, staffing levels, and quality measures. Choosing a Medicare-certified home ensures that your coverage will be recognized.
What to ask your doctor and hospital before discharge
Before leaving the hospital, ask your doctor or discharge planner these questions: Will I need skilled nursing care after I leave the hospital? How long do you expect I will need it? Which nursing homes near me are Medicare-certified? Can you help arrange my admission? Will my stay be covered by Medicare?
Also ask about your hospital stay: Does my three-day stay count as inpatient admission, or was I on observation status? (If you were on observation, it may not count, and you should ask the hospital to review this with your doctor.) Request a copy of your hospital discharge summary and any orders for continued care — the nursing home will need these documents.
Frequently Asked Questions
If I stay in a nursing home for 100 days, how much will I owe?
You will owe nothing for days 1–20. For days 21–100, you pay the daily copay amount (currently $200 per day in 2024, though this changes yearly). That means 80 days × $200 = $16,000 out of pocket, though you should confirm the current copay with Medicare or your nursing home. After day 100, you owe all costs.
Can I use Medicare to stay in a nursing home permanently?
No. Medicare covers only up to 100 days per benefit period, and only for skilled care after a hospital stay. If you need permanent or long-term residential care, you will need Medicaid, private payment, or long-term care insurance. Medicaid does cover long-term custodial care in nursing homes if you meet income and asset limits.
What happens if I need more than 100 days of care?
After 100 days, Medicare stops paying. You can continue staying in the nursing home if you pay privately, or you may transition to Medicaid if you meet the income and asset requirements. Some people also have long-term care insurance that covers costs after Medicare ends. Talk to the nursing home's financial counselor about your options.
Does Medicare cover nursing home care if I was never hospitalized?
No. Medicare requires a hospital stay of at least three consecutive days before it will cover nursing home care. If your doctor recommends a nursing home without a hospital stay, Medicare will not pay. You would need to pay privately or use Medicaid if you may have access to.
Will my Medigap or Medicare Advantage plan cover the copay for days 21–100?
Some Medigap plans cover part or all of the skilled nursing facility copay, but coverage varies by plan. Medicare Advantage plans have their own rules and may cover the copay differently. Check your plan documents or call your plan to find out what your nursing home copay will be.