Does Medicare Pay for Nursing Home Care? The Real Answer
Key Takeaways
- Medicare pays for nursing home care only in a short, limited way: up to 100 days per benefit period of skilled care after a qualifying hospital stay. It does not pay for long-term stays.
- You need a hospital stay of at least 3 days in a row as an inpatient. Time under observation does not count.
- In 2026, days 1-20 cost $0 after the $1,736 Part A deductible. Days 21-100 cost $217 per day, up to $17,360 for those 80 days.
- After day 100, or when skilled care is no longer needed, you pay all costs. The national median for a private room is $10,798 per month (2025).
- If you think Medicare is ending coverage too soon, you can ask for a fast appeal, but you must act by noon the day before coverage ends.
After a hospital stay, a social worker says the next step is a nursing home, and you ask the question every family asks: will Medicare pay for this? The honest answer is “partly, for a while, and only if specific rules are met.” Those rules are where families get caught off guard.
This article explains exactly when Medicare pays for nursing home care, how much it pays, how many days you get, and what happens on the day coverage stops. You will also see how Medigap and Medicare Advantage change the picture, and where the money comes from after Medicare ends. Every rule comes from official Medicare sources: Medicare.gov and the Centers for Medicare & Medicaid Services (CMS).
Does Medicare Pay for Nursing Home Care? The Short Answer
Medicare Part A pays for short-term skilled nursing care in a nursing home, which Medicare calls a skilled nursing facility (SNF). It does not pay for long-term custodial care, which is what most nursing home residents need over time.
Here is what you pay in 2026 for each benefit period:
| Days in the nursing home | Your cost (2026) |
|---|---|
| Days 1-20 | $0, after the $1,736 deductible |
| Days 21-100 | $217 per day |
| Day 101 and beyond | All costs |
The $1,736 deductible is the Part A hospital deductible. Medicare does not charge it a second time for SNF care if you already paid it for the hospital stay in the same benefit period. If a person uses all 80 coinsurance days, that comes to $17,360 (80 days x $217).
Note: Medicare Advantage plans may charge copayments during the first 20 days, so check the plan.
The Rules You Must Meet to Get Medicare Nursing Home Coverage
Medicare covers a nursing home stay only if all of these are true:
- A qualifying hospital stay. You need a medically necessary inpatient stay of at least 3 days in a row. The count starts on the admission day and does not include the discharge day.
- Timely admission. You generally enter the nursing home within 30 days of leaving the hospital.
- Daily skilled care. A provider decides you need skilled nursing or therapy every day, given by or under the supervision of skilled staff.
- A Medicare-certified facility. The nursing home must be certified by Medicare.
- A related condition. The need must relate to a condition treated in the hospital, or to a new condition that began during the SNF stay for that condition.
- Days left. You still have days available in your benefit period.
Three of these rules cause most of the surprises.
The 3-Day Rule and Observation Status
Time in the emergency room or under observation does not count toward the 3 days, even if your loved one stays overnight. Before a discharge, ask the hospital: “Was my parent formally admitted as an inpatient, or placed under observation?” The answer decides whether Medicare will pay.
The 3-day rule may be waived for certain doctors in an accountable care organization (ACO) or for some Medicare Advantage plans.
The 30-Day Window
The 30 days start after the hospital discharge day. CMS allows a longer gap when it is medically appropriate to wait, for example when planned treatment has to be delayed for a medical reason. Do not count on an exception without confirming it with the hospital and the nursing home.
What “Daily” Means
Skilled care must be needed and given on essentially a 7-days-a-week basis. If the stay is based only on rehabilitation therapy, therapy on at least 5 days a week meets the rule. Therapy less than 5 days a week does not. A break of a day or two in therapy does not, by itself, end coverage.
What Medicare Pays For in a Skilled Nursing Facility
While your loved one qualifies, Part A covers these services:
- A semi-private room and meals
- Skilled nursing care
- Physical, occupational and speech-language therapy, when needed to meet a health goal
- Medical social services and dietary counseling
- Medications and the medical supplies and equipment used in the facility
- Ambulance transport to the nearest supplier of needed services the facility does not offer, when other transportation would endanger health
Medicare also keeps paying for some care when the stay itself is not covered. Part B still helps with doctor visits and with physical, speech or occupational therapy, even if you get these services while living in a nursing home.
What Medicare Does Not Pay For
Medicare does not pay for custodial care when it is the only care you need. That means help with everyday tasks such as bathing, dressing and eating. It also generally does not cover long-term nursing home stays unless you need skilled nursing care. Medicare says it doesn’t pay for long-term care at all.
In practice, if your loved one needs a place to live with help but not skilled care every day, Medicare does not pay the bill. Coverage can stop before day 100 once daily skilled care is no longer needed, and after day 100 you pay all costs.
For a full picture of nursing home costs and who pays, see our complete guide to nursing homes.
Does Medicare Still Pay If Your Loved One Isn’t Getting Better?
A common worry is that Medicare stops paying once progress stops. That is not the rule. Under the Jimmo settlement, approved by a federal court on January 24, 2013, SNF coverage “does not turn on the presence or absence of a beneficiary’s potential for improvement,” but on the person’s need for skilled care. Skilled care is covered when it is needed to maintain a condition or to prevent or slow further decline, so long as the person still requires skilled care.
If a decision says “no more improvement” and nothing else, ask the nursing home to explain whether your loved one still needs skilled care to maintain their condition.
What Happens When Medicare Coverage Ends
You should get a written Notice of Medicare Non-Coverage from the nursing home at least 2 days before covered services end. If you do not get one, ask for it.
If you think the stay is ending too soon, you can ask for a fast appeal:
- Read the notice and find the phone number of the independent reviewer named on it. Medicare calls this reviewer a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO).
- Call no later than noon the day before the termination date on the notice.
- The reviewer must decide by the close of business the day after it gets the information it needs.
If you win, Medicare may keep covering the care, subject to the usual coinsurance. If you lose, you do not owe for services before the coverage end date on the notice. Services after that date may be your responsibility. If you miss the deadline, you can still ask your plan for a fast reconsideration, but coverage applies only if the decision goes in your favor.
How Benefit Periods Work
Everything above is counted per benefit period. A benefit period starts on the first day the patient is an inpatient in a hospital or SNF. It ends after 60 consecutive days without inpatient hospital or SNF care.
There is no limit on how many benefit periods a person can have, but you pay the Part A deductible each time a new one starts. So a person who goes 60 consecutive days without hospital or SNF care, and then has a new qualifying hospital stay, starts a fresh benefit period with a fresh set of 100 days.
Do Medigap and Medicare Advantage Change the Answer?
Medigap
Some Medigap (Medicare Supplement) plans pay the $217-a-day coinsurance for days 21-100. Here is how it breaks down in 2026:
| Medigap plan | Pays SNF coinsurance |
|---|---|
| C, D, F, G, M, N | 100% |
| L | 75% |
| K | 50% |
| A, B | Not covered |
Not everyone can buy Plan C or Plan F, and eligibility depends on when you first became eligible for Medicare. Medigap does not pay for long-term care.
Medicare Advantage
Medicare Advantage plans may waive the 3-day hospital stay and may charge copayments in the first 20 days. For nursing home care, plans usually do not help pay unless the nursing home has a contract with the plan. Before agreeing to a facility, ask the plan whether it is in the network and what you will pay each day.
How to Pay When Medicare Stops
Once Medicare ends, the bill falls on the family unless another program steps in. The national median cost of a nursing home is $9,581 per month for a semi-private room and $10,798 per month for a private room (2025, CareScout/Genworth Cost of Care Survey, which reports $315 and $355 a day). See nursing home costs in your state for local numbers.
The main options are:
- Medicaid. Medicaid may cover long-term care in a nursing home if you meet your state’s requirements. Income and asset rules vary by state.
- Long-term care insurance. If a policy exists, check how it pays for nursing home care. See our article on whether long-term care insurance is worth it.
- Private pay. Many families pay from savings at first, then apply for Medicaid when assets run low.
Assisted living works differently from nursing homes. For that, see Does Medicare Cover Assisted Living?
Frequently Asked Questions
How many days of nursing home care does Medicare pay for?
Up to 100 days per benefit period, and only while skilled care is needed. In 2026, you pay $0 for days 1-20 after the $1,736 deductible, and $217 per day for days 21-100. After day 100, you pay all costs.
Does Medicare pay for a nursing home without a 3-day hospital stay?
Usually not. Medicare requires at least 3 days in a row as an inpatient, and observation or emergency room time does not count. The rule may be waived for certain accountable care organization doctors and some Medicare Advantage plans, so ask the plan or the hospital before the move.
Does Medicare pay for nursing home care after 100 days?
No. After day 100 of a benefit period, you pay all costs. A new benefit period, and a new set of 100 days, begins only after the person has gone 60 consecutive days without inpatient hospital or skilled nursing facility care and then has a new qualifying hospital stay.
Can Medicare stop paying if my parent is not improving?
Coverage does not depend on whether a person is improving. Under the Jimmo settlement, it depends on whether skilled care is still needed, including to maintain a condition or slow decline. If the nursing home says coverage is ending, ask for the written Notice of Medicare Non-Coverage and consider a fast appeal.
Does Medigap pay the $217 a day?
Some plans do. In 2026, Medigap Plans C, D, F, G, M and N pay 100% of the skilled nursing facility coinsurance for days 21-100. Plan L pays 75% and Plan K pays 50%. Plans A and B do not cover it.
Sources
- Medicare.gov. “Skilled Nursing Facility Care.” https://www.medicare.gov/coverage/skilled-nursing-facility-care. Accessed: October 2026.
- Medicare.gov. “Nursing Home Care.” https://www.medicare.gov/coverage/nursing-home-care. Accessed: October 2026.
- Medicare.gov. “Long-Term Care Coverage.” https://www.medicare.gov/coverage/long-term-care. Accessed: October 2026.
- Medicare.gov. “Medicare Costs.” https://www.medicare.gov/basics/costs/medicare-costs. Accessed: October 2026.
- Centers for Medicare & Medicaid Services. “Medicare Benefit Policy Manual, Chapter 8: Coverage of Extended Care (SNF) Services Under Hospital Insurance.” https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c08pdf.pdf. Accessed: October 2026.
- Centers for Medicare & Medicaid Services. “Medicare General Information, Eligibility, and Entitlement, Chapter 3: Deductibles, Coinsurance Amounts, and Payment Limitations.” https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ge101c03.pdf. Accessed: October 2026.
- Centers for Medicare & Medicaid Services. “Jimmo Settlement.” https://www.cms.gov/medicare/settlements/jimmo. Accessed: October 2026.
- Medicare.gov. “Fast Appeals.” https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals/fast-appeals. Accessed: October 2026.
- Medicare.gov / CMS. “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.” https://www.medicare.gov/publications/02110-choosing-a-medigap-policy.pdf. Accessed: October 2026.
- Medicare.gov. “Compare Medigap Plan Benefits.” https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits. Accessed: October 2026.
- CareScout / Genworth Financial. “CareScout Releases 2025 Cost of Care Survey Results.” https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results. Published: March 2026.
