Medicare pays for up to 100 days of skilled nursing facility care per benefit period, but only if you meet specific eligibility requirements and need skilled medical care. Most nursing home stays are not fully covered because Medicare draws a hard line between skilled nursing care and the kind of everyday personal assistance that makes up the majority of nursing home life.
The 100-Day Coverage Window
Medicare Part A covers skilled nursing facility care in two phases. For the first 20 days, Medicare pays the full cost with no out-of-pocket expense to you. Starting on day 21 through day 100, you pay a daily coinsurance amount: $209.50 per day in 2025, rising to $217.00 per day in 2026. That coinsurance adds up quickly. If you stay the full 80 days of the coinsurance period, you’d owe roughly $16,760 to $17,360 depending on the year.
After day 100, Medicare pays nothing. You become responsible for the entire daily cost, which at many facilities runs $8,000 to $12,000 per month or more depending on location.
What You Need to Qualify
Getting into a nursing facility doesn’t automatically trigger Medicare coverage. You typically need a qualifying inpatient hospital stay of at least three consecutive days (not counting the discharge day) before transferring to a skilled nursing facility. This is one of the most common traps in Medicare coverage: if you were in the hospital under “observation status” rather than formally admitted as an inpatient, those days don’t count toward the three-day requirement, even if you spent several nights in a hospital bed.
Beyond the hospital stay, you must need skilled care that can only be provided in a nursing facility. A doctor has to certify that your care is medically necessary. The facility must also be Medicare-certified.
Skilled Care vs. Custodial Care
This distinction is the single biggest reason people are surprised by what Medicare won’t cover. Skilled care means services that require the training and judgment of licensed professionals: wound care with sterile dressings, IV medications, physical therapy after a hip replacement, or monitoring an unstable medical condition. Medicare covers this.
Custodial care is help with daily activities like bathing, dressing, eating, getting in and out of bed, and using the bathroom. It also includes basic health tasks most people can do themselves, like applying eye drops. Medicare does not cover custodial care, and most nursing home care falls into this category. If the only reason you’re in a nursing home is that you need help with daily living rather than active medical treatment or rehabilitation, Medicare won’t pay regardless of how many days you’ve been there.
You Don’t Have to Be “Getting Better”
A common misconception is that Medicare stops paying once you plateau and stop improving. That’s not how it works. A 2013 legal settlement with the federal government, known as the Jimmo settlement, clarified that Medicare covers skilled nursing and therapy services when they’re needed to maintain your current condition or prevent further decline. The key question isn’t whether you’re improving. It’s whether you still need a skilled professional to safely carry out your care plan. If a trained nurse or therapist is necessary to keep you stable or slow deterioration, that qualifies as skilled care.
This matters in practice because facilities sometimes tell patients (or their families) that coverage is ending because the patient has stopped making progress. If you’re told this, it’s worth questioning. The legal standard is about the need for skilled care, not the trajectory of recovery.
How Benefit Periods Reset
The 100-day limit isn’t a once-in-a-lifetime cap. It resets with each new “benefit period.” A benefit period ends when you haven’t received any inpatient hospital care or skilled nursing facility care for 60 consecutive days. Once that 60-day gap passes, a new benefit period begins the next time you’re admitted, and you get a fresh 100 days of coverage.
This means someone with recurring medical needs could receive multiple rounds of covered nursing facility care over the years, as long as each stay is preceded by the required hospital admission and separated by at least 60 days without inpatient or skilled nursing care.
What Happens When Coverage Ends
The facility must give you written notice at least two days before Medicare-covered services stop. This document, called a Notice of Medicare Non-Coverage, explains the date your coverage will end and, critically, how to appeal the decision. You have the right to request an immediate review from a Quality Improvement Organization, an independent body that evaluates whether the termination is appropriate. If you file the appeal before your coverage end date, Medicare continues paying while the review is underway.
Don’t ignore this notice or assume the decision is final. Appeals are resolved quickly, and some are decided in the patient’s favor.
How Medigap Plans Help With Costs
If you have a Medigap (Medicare Supplement) policy, it may cover the daily coinsurance you’d owe for days 21 through 100. Not all plans include this benefit, and the differences are significant:
- Plans C, D, F, and G cover 100% of the skilled nursing coinsurance
- Plan K covers 50%
- Plan L covers 75%
- Plans A, B, M, and N do not cover any of the coinsurance
If you’re on Plan G, for example, you’d pay nothing out of pocket for the entire 100-day skilled nursing stay. On Plan N, you’d owe the full $209.50 to $217.00 per day starting on day 21. Over a long stay, that difference can amount to tens of thousands of dollars.
Medicare Advantage Plans
If you have a Medicare Advantage plan instead of Original Medicare, your skilled nursing coverage must be at least as generous as the standard 100-day benefit. However, Advantage plans often add requirements like prior authorization before admitting you to a facility, and they may restrict which facilities you can use to those in their network. Some Advantage plans waive the three-day hospital stay requirement, which can be a meaningful advantage if you need nursing facility care without a preceding hospitalization. Check your specific plan’s terms, because the details vary widely between insurers.
Paying for Long-Term Nursing Home Care
Once Medicare’s 100 days are exhausted, the most common funding sources for ongoing nursing home care are personal savings, long-term care insurance (if purchased before the need arose), and Medicaid. Medicaid does cover long-term custodial nursing home care, but it’s a means-tested program. You generally must have very limited income and assets to qualify. Many families go through a spend-down process, using personal resources until they meet Medicaid’s financial thresholds.
The average nursing home stay in the United States lasts considerably longer than 100 days, which is why Medicare’s benefit, while valuable for post-hospital rehabilitation, was never designed to be a long-term care solution. Planning for that gap is one of the most consequential financial decisions people face as they age.