Does Medicare cover nursing home care?

What Medicare does cover

Medicare Part A covers care in a skilled nursing facility when all of these are true:

• You had a qualifying inpatient hospital stay — traditionally three consecutive days, not counting the discharge day;
• You enter a Medicare-certified skilled nursing facility, generally within 30 days of leaving the hospital;
• A doctor certifies that you need daily skilled care — nursing or therapy that only trained professionals can provide — for the condition treated in the hospital.

Coverage is capped at 100 days per benefit period: roughly the first 20 days at no cost to you, and the remaining days with a daily coinsurance amount that Medicare resets each year. After day 100, Medicare pays nothing toward that stay.

The traps in the fine print

• "Observation status." Time in a hospital bed under observation rather than admitted as an inpatient does not count toward the three-day requirement — and patients routinely do not know which status they are in. Ask directly, every day: "Am I admitted as an inpatient, or under observation?"
• Medicare Advantage is different. Advantage plans must cover at least what Original Medicare covers, but many waive the three-day rule while adding prior authorization and network restrictions. Get the plan's rules in writing before choosing a facility.
• Coverage can end before day 100. If the facility determines you are no longer improving or no longer need skilled care, coverage stops. You have the right to appeal, and the facility must give you notice explaining how.
• The benefit period resets after 60 consecutive days out of a hospital or skilled nursing facility — which can open a new 100 days after a later hospitalization.

What to do with the 100 days

Treat the covered stay as a planning window, not a solution. Families who use it to apply for Medicaid, evaluate facilities, and gather financial documents avoid the scramble that hits on day 101. Meanwhile, use the stay to evaluate the building from the inside — and check its record: search any facility in our state-by-state records, and see how Medicaid coverage works for the long term.

Current dollar figures change every year. Verify coinsurance amounts at Medicare.gov or by calling 1-800-MEDICARE.

Common questions

How many days will Medicare pay for a nursing home?

Up to 100 days per benefit period, and only for skilled care following a qualifying hospital stay. Roughly the first 20 days have no coinsurance; days 21 through 100 carry a daily coinsurance that changes annually. After 100 days Medicare pays nothing for that stay.

Does Medicare pay for long-term nursing home care?

No. Medicare never covers long-term custodial care — help with bathing, dressing, eating, and supervision — regardless of need. Long-term nursing home care is paid by Medicaid, private funds, or long-term care insurance.

Does Medicare cover assisted living?

No. Medicare does not pay for room and board in assisted living. Some medical services delivered there, such as physician visits or physical therapy, may be billed to Medicare separately.

What is the three-day rule?

To qualify for Medicare skilled nursing coverage you generally need three consecutive days as a hospital inpatient. Time spent under observation status does not count, even if you occupied a hospital bed. Many Medicare Advantage plans waive this requirement.

Check a specific facility

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