Medicare covers some nursing home costs, but only under specific conditions — and only for a limited time

Medicare will pay for a nursing home stay, but not the way most people think. It does not cover custodial care (help with daily living like bathing or dressing) for any length of time. It covers skilled nursing care — medical treatment that requires a nurse or therapist — for up to 100 days after a hospital stay, and only if you meet strict requirements. After that, you pay the full cost yourself, unless you have a supplemental insurance policy or your income is low enough for Medicaid.

The difference between what Medicare covers and what it does not is the difference between recovering from surgery and living in a facility because you need help. Understanding that line saves you from discovering mid-stay that you are paying thousands of dollars a month out of pocket.

Key Takeaways

  • Medicare covers skilled nursing care for up to 100 days only after a hospital stay of at least three nights, and only if a doctor orders it as part of your recovery.
  • You pay nothing for days 1–20, a copay of around $200 per day for days 21–100 (the exact amount changes yearly), and the full cost after day 100.
  • Medicare does not cover custodial care — help with bathing, dressing, eating, or toileting — no matter how long you stay or how much you need it.
  • If you need long-term care after your 100 days end, Medicaid may cover it if your income and assets fall below your state's limits, but Medicaid rules vary widely by state.
  • Supplemental insurance (Medigap) does not cover nursing home costs; long-term care insurance is a separate product that some people buy years in advance.

What Medicare Covers: The Three-Day Hospital Rule

To get Medicare to pay for any nursing home stay, you must first spend at least three nights in a hospital as an inpatient — not in the emergency room, not as an outpatient observation patient, but admitted to a hospital bed. The hospital stay and the nursing home stay must be related to the same condition or injury. A doctor must order the nursing home care as part of your recovery plan before you leave the hospital.

This is the most common reason people miss coverage: they spend two nights in the hospital, get discharged to a nursing home, and discover Medicare will not pay because they did not meet the three-night threshold. Observation status — which looks like a hospital stay but counts differently — does not count toward the three nights. Ask the hospital directly whether you are admitted as an inpatient or on observation status; do not assume.

Once you meet the three-night rule, Medicare covers skilled nursing care — physical therapy, occupational therapy, speech therapy, wound care, medication management, or other medical treatment that requires a licensed nurse or therapist. It does not cover a room straightforward because you need somewhere to live while you recover.

How Much You Pay: Days 1 Through 100

Medicare Part A covers the full cost of the first 20 days in a skilled nursing facility with no copay. Starting on day 21, you pay a copay per day. In 2024, that copay is approximately $200 per day, though the exact amount is set by Medicare each year and may change. You pay this copay for days 21 through 100.

After day 100, Medicare stops paying entirely. You then owe the full cost of the nursing home — which typically ranges from $8,000 to $15,000 per month depending on the facility and your location, but varies significantly. At that point, you either pay out of pocket, rely on Medicaid if you meet income and asset limits, or have a long-term care insurance policy that covers it.

The copay applies only to days you actually stay. If you are discharged on day 45, you pay the copay for days 21–45 and nothing more. If you improve and go home on day 19, you pay nothing.

What Medicare Does Not Cover

Medicare does not cover custodial care — the help with daily living that most people associate with nursing homes. Bathing, dressing, eating, toileting, and general supervision are custodial care. If that is the main reason you need a nursing home, Medicare will not pay, even if you stay for years. Many people enter a nursing home thinking Medicare will cover them, only to learn weeks or months later that their care is classified as custodial and they are responsible for the bill.

Medicare also does not cover a private room unless medically necessary, a television or telephone in your room, or personal care items. It does not cover the facility's room and board costs — only the skilled nursing and therapy services. Some facilities bundle these costs together on one bill, which can make it confusing to see what Medicare is actually paying for.

If you need ongoing skilled care after day 100 — for example, you still need physical therapy or wound care — you may be able to continue at the facility, but you will pay the full cost yourself. Medicare does not extend coverage past 100 days under any circumstances.

Medicaid as a Backup for Long-Term Care

If you need nursing home care beyond 100 days and cannot pay out of pocket, Medicaid may cover it — but only if your income and assets fall below your state's limits. Medicaid is a joint federal and state program, so the rules, income limits, and asset limits vary by state. Some states are more generous than others; some cover more services.

To be may be able to access for Medicaid nursing home coverage, you typically must have monthly income below a certain threshold (often around $2,000 to $2,500, but this varies) and assets below a limit (often around $2,000 to $3,000 in your name, though your home and one vehicle are usually excluded). Medicaid also has complex rules about what counts as an asset and whether you can transfer assets to family members without penalty.

explore for Medicaid is separate from Medicare. You explore through your state's Medicaid office or a local social worker. The process can take weeks or months. If you think you may need Medicaid coverage, start the conversation with the nursing home's social worker or a local Area Agency on Aging as soon as possible, because timing matters and some facilities have waiting lists for Medicaid residents.

Supplemental Insurance and Long-Term Care Insurance

Medigap (supplemental insurance) does not cover nursing home costs. Medigap policies fill gaps in Medicare coverage — like copays and deductibles — but they do not extend Medicare's 100-day limit or cover custodial care. If you have a Medigap policy, it will help pay your copay for days 21–100, but nothing beyond that.

Long-term care insurance is a separate product that some people buy years before they need care. It covers nursing home stays, assisted living, and in-home care, and it can last for years or for life depending on the policy. However, long-term care insurance is expensive, has strict underwriting rules, and must be purchased while you are still in good health. Most people do not have it.

If you are considering long-term care insurance, you need to buy it well before you think you might need care — typically in your 50s or 60s. Once you have a diagnosis of dementia, heart disease, or other serious condition, you will not be able to buy it. Talk to an insurance agent or financial planner about whether it makes sense for your situation.

What to Do Before Entering a Nursing Home

Before you or a family member enters a nursing home, ask the facility directly: "Does Medicare cover this stay?" Ask them to explain in writing what Medicare will pay for, what you will pay for, and when your coverage ends. Do not rely on a verbal answer; get it in writing so you have a record.

Ask the hospital discharge planner whether you meet the three-night inpatient requirement and whether the nursing home stay is ordered as part of your recovery. If you are on observation status, ask what that means for your nursing home coverage. Write down the names of the people you spoke with and the date.

If you think you may need care beyond 100 days, ask the nursing home's social worker about Medicaid and whether the facility accepts Medicaid residents. Ask what the process and timeline are for explore. Some facilities have limited Medicaid beds and long waiting lists, so knowing this early matters.

Keep copies of your hospital discharge papers, the doctor's order for nursing home care, and any letters from Medicare or the nursing home about what is covered. These documents will be important if there is a dispute about what you owe.

Frequently Asked Questions

Does Medicare cover a nursing home if I did not spend three nights in the hospital first?

No. The three-night inpatient hospital stay is a requirement, not a guideline. If you spent two nights or were on observation status, Medicare will not cover the nursing home stay. Some people appeal this decision, but the rule is strict. Ask the hospital before discharge whether you meet the requirement.

What happens if I run out of money before my 100 days are up?

You can explore for Medicaid while you are still in the nursing home. Medicaid will cover your care going forward if you meet the income and asset limits. The nursing home's social worker can help you start the process. There is no penalty for running out of money; Medicaid does not require you to have spent down your assets before you explore.

Can I use my Medicare Advantage plan instead of Original Medicare for nursing home coverage?

Medicare Advantage plans must cover the same skilled nursing care that Original Medicare does, but the copays and rules may be different. Check your plan's documents or call the plan directly to understand what you will pay. Some Advantage plans have different copays or require you to use in-network facilities.

If I have a Medigap policy, does it cover nursing home costs?

Medigap will help pay your copay for days 21–100, but it does not extend coverage past 100 days or cover custodial care. After day 100, you are responsible for the full cost. Long-term care insurance is a different product and covers nursing home stays longer than 100 days.

Can I move to a different nursing home and restart my 100-day clock?

No. Your 100 days are tied to the hospital stay that triggered the coverage, not to the facility. If you move to a different nursing home, your days continue to count down from where they left off. You cannot restart the clock by changing facilities.