Medicare covers short-term skilled nursing care in a nursing home, but it does not pay for long-term custodial stays. This is one of the most common and costly misunderstandings in retirement planning. Medicare Part A will cover up to 100 days in a skilled nursing facility per benefit period, but only when you need medical care like rehabilitation after a hospital stay. If you or a loved one needs ongoing help with daily activities like bathing, dressing, or eating, Medicare will not cover it.
What Medicare Actually Covers
Medicare Part A covers stays in a skilled nursing facility when the care you need is medical in nature. That means services like physical therapy after a hip replacement, IV medications, wound care, or other treatments that require trained nursing staff. The facility must be Medicare-certified, and your care must be ordered by a doctor.
The key word is “skilled.” Medicare draws a hard line between skilled care (which requires professional medical expertise) and custodial care (which helps with everyday tasks). If you need someone to help you get dressed and prepare meals but don’t require medical treatment, that falls under custodial or long-term care, and Medicare pays nothing toward it. You’re responsible for 100% of those costs.
The 3-Day Hospital Rule
Before Medicare will cover any skilled nursing facility stay, you typically need a qualifying inpatient hospital stay of at least 3 consecutive days. The counting is important here: the day you’re admitted counts, but the day you’re discharged does not. You must enter the skilled nursing facility within 30 days of leaving the hospital.
One critical detail catches many families off guard. If you’re in the hospital under “observation status” rather than formally admitted as an inpatient, those days do not count toward the 3-day requirement. You can spend several nights in a hospital bed, receive treatment, and still not qualify for skilled nursing coverage because the hospital classified your stay as observation. Always ask whether you’ve been admitted as an inpatient or placed under observation.
How the 100-Day Limit Works
Medicare measures your skilled nursing coverage in “benefit periods.” A benefit period starts the day you’re admitted as an inpatient to a hospital or skilled nursing facility. It ends once you’ve gone 60 consecutive days without receiving inpatient hospital care or skilled nursing care. After that 60-day gap, a new benefit period begins if you’re readmitted, and the 100-day clock resets.
Within each benefit period, the cost breakdown looks like this:
- Days 1 through 20: Medicare pays the full cost. You pay nothing beyond your Part A deductible.
- Days 21 through 100: You pay a daily coinsurance of $209.50 in 2025 (up from $204.00 in 2024). Medicare covers the rest.
- Days 101 and beyond: Medicare coverage ends entirely. You pay all costs out of pocket.
That coinsurance for days 21 through 100 adds up quickly. At $209.50 per day, a full 80 days of coinsurance would cost you roughly $16,760. Medigap (Medicare Supplement Insurance) policies can help cover some or all of that coinsurance, depending on your plan.
Medicare Advantage Plans May Differ
If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your skilled nursing coverage must be at least as generous as Original Medicare, but the rules around accessing it can differ. Many Medicare Advantage plans require prior authorization before they’ll approve a skilled nursing facility stay. Some plans have waived the 3-day hospital stay requirement, though this varies by plan. Your out-of-pocket costs, network restrictions, and approval processes will depend on your specific plan, so check with your insurer before assuming coverage mirrors Original Medicare exactly.
Long-Term Nursing Home Care Is Not Covered
This is the part that surprises most people. Medicare explicitly does not pay for long-term care. If someone needs to live in a nursing home permanently because they can no longer care for themselves, Medicare will not cover the room, board, or personal care assistance. This applies whether the person has Original Medicare, a Medigap policy, or most private health insurance.
Long-term care includes help with what the healthcare system calls “activities of daily living,” things like bathing, dressing, using the bathroom, eating, and getting around. It also includes services like home-delivered meals, adult day programs, and transportation. These are real, necessary forms of care, but Medicare categorizes them as non-medical and excludes them from coverage.
The average cost of a private room in a nursing home runs well over $100,000 per year in many parts of the country. Without Medicare covering these costs, families typically pay through some combination of personal savings, long-term care insurance (if purchased years earlier), or Medicaid once assets are depleted.
How Medicaid Fills the Gap
Medicaid is the primary payer for long-term nursing home care in the United States. Unlike Medicare, Medicaid does cover custodial care in a nursing facility, but it’s a means-tested program. You must meet strict income and asset limits to qualify, and those limits vary by state.
Many people transition from Medicare-covered skilled nursing care to Medicaid-funded long-term care once their 100 days of Medicare coverage run out and they’ve spent down their assets. Even after this transition, Medicare still plays a role. It continues to cover hospital visits, doctor’s services, prescription drugs, and medical supplies while someone lives in a nursing home. Medicare and Medicaid work alongside each other rather than one replacing the other.
Hospice Care in a Nursing Home
If you’re living in a nursing home and choose hospice care, Medicare Part A covers the hospice services themselves, including pain management, symptom control, and emotional support. However, Medicare does not cover room and board in the nursing facility. You or your family would still need to pay for the cost of living in the facility, either out of pocket or through Medicaid. If the hospice team determines you need short-term inpatient care or respite care, Medicare will cover that stay in full.
Comparing Nursing Home Quality
Medicare maintains a free tool called Care Compare on Medicare.gov that lets you search for Medicare-certified nursing homes by location and compare them side by side. Facilities are rated on quality of care, staffing levels, and health inspection results. If you’re evaluating nursing homes for yourself or a family member, this tool provides a useful starting point for narrowing your options before visiting in person.