Does Medicare pay for nursing home care?

Home › Guides › Does Medicare pay for nursing home care?

By Nursing Homes In Each State · Published October 31, 2026 · Last updated October 31, 2026

Short-term skilled care vs long-term custodial care

The word "nursing home" covers two very different kinds of stay, and Medicare treats them differently.

Skilled care is care that has to be given or supervised by licensed nurses or therapists: wound care, IV medicines, physical therapy after a hip replacement, speech therapy after a stroke. It is usually short-term, with a goal such as getting strong enough to go home. Medicare Part A can cover this in a Medicare-certified skilled nursing facility (SNF).

Custodial care is ongoing help with everyday activities: bathing, dressing, eating, using the bathroom, moving around. Medicare.gov is direct about this: "Medicare doesn't cover custodial care if it's the only care you need." Most people who live in a nursing home for months or years are there mainly for custodial care, so Medicare does not pay for their room and care.

Medicare Part B still pays for covered doctor visits and for physical, speech and occupational therapy while someone lives in a nursing home, even when Part A isn't paying for the stay.

The 3-day inpatient hospital rule

Under Original Medicare, Part A covers a skilled nursing stay only if all of these are true:

• You had a medically necessary inpatient hospital stay of at least 3 days in a row. The day you're admitted counts; the day you leave doesn't.
• You generally go into the skilled nursing facility within 30 days of leaving the hospital.
• You need skilled nursing or therapy services every day, for a condition treated in the hospital (or one that started during the SNF stay for that condition).
• The facility is certified by Medicare, and you have days left in your benefit period.

Medicare.gov notes one exception: the 3-day minimum may be waived if your doctor belongs to an Accountable Care Organization approved for a "Skilled Nursing Facility 3-Day Rule Waiver." Ask the hospital or your doctor whether that applies to you.

Watch out for observation status

Time you spend in the hospital under observation, or in the emergency room before you're formally admitted, does not count toward the 3 days, even if you stay overnight in a regular hospital bed. You can be in the hospital for three nights and still not qualify because you were an outpatient the whole time.

If someone you care for is in the hospital and a nursing home stay is likely, ask the care team plainly: "Is she an inpatient, or under observation?" Hospitals must tell Medicare patients in writing, on a form called the Medicare Outpatient Observation Notice, when they are getting observation services for more than 24 hours. Medicare.gov also says you can appeal past hospital stays, back to January 2009, if the hospital changed your status from inpatient to outpatient observation.

What you pay: days 1 to 20 and days 21 to 100

These are the 2026 amounts Medicare.gov publishes for each benefit period under Original Medicare:

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 days in a row without inpatient hospital or skilled nursing care. A new benefit period brings a new deductible and a fresh set of 100 SNF days, but you still need a new qualifying hospital stay.

"Up to 100 days" is a limit, not a promise. Medicare pays only while you still need and are getting daily skilled care. Many people stop qualifying well before day 100, for example when therapy ends because they've stopped improving or no longer need a skilled service. The facility must give you written notice before Medicare coverage ends, and the notice explains how to ask for a fast appeal.

Many Medigap (Medicare Supplement) policies pay some or all of the daily coinsurance for days 21 to 100. Check the benefits of the specific policy.

Medicare Advantage plans work differently

If you get Medicare through a Medicare Advantage plan (Part C), the plan sets its own rules for skilled nursing care, within limits Medicare allows. According to Medicare.gov:

• Plans may waive the 3-day hospital stay requirement.
• You may be charged copayments during the first 20 days, which Original Medicare doesn't charge.
• Plans often don't pay for nursing home care unless the home has a contract with the plan.

Many plans also require approval in advance (prior authorization) before a stay. Before you choose a facility, call the plan, ask which skilled nursing facilities are in its network and what you'll pay per day, and get the answer in writing if you can.

What happens at day 101, or when skilled care ends

Once Medicare stops paying, the person can stay in the same home, but someone else has to pay. The usual options are:

• Private payment, from savings, income or family help. CMS doesn't publish nursing home prices, so ask each home for its daily rate.
• Long-term care insurance, if the person has a policy. Check its waiting period and daily benefit.
• Medicaid, for people who meet their state's income, asset and level-of-care rules.

Medicaid is the main public payer for long-term nursing home care. Medicaid.gov says nursing facility services are "required to be provided by state Medicaid programs for individuals age 21 or older who need them," but only in homes certified for Medicaid and only when the person is eligible. Each state sets its own financial rules and level-of-care test, so contact your state Medicaid office early; applications can take weeks.

Questions to ask before a hospital discharge

1. Was the stay inpatient for at least 3 days, not counting the discharge day?
2. Is the skilled nursing facility you want certified by Medicare, and in the network if you have a Medicare Advantage plan?
3. Does the facility also accept Medicaid, in case a longer stay is needed later?
4. What skilled services are planned, and what are the goals for going home?
5. What will the daily cost be after day 20, and does your Medigap or other coverage pay it?

For free, unbiased help with Medicare questions, contact your State Health Insurance Assistance Program (SHIP), or call 1-800-MEDICARE. For questions about a specific person's care, talk to their doctor or the hospital discharge planner. To learn more about how these facilities work, read what a skilled nursing facility is, and use CMS's star ratings to compare homes on your shortlist.

More guides

• What is a skilled nursing facility?

  What "skilled nursing facility" means, how it differs from a nursing home and rehab, who works there, and how CMS rates them.

• Assisted living vs nursing home: what's the difference?

  How the two differ on care, regulation, inspections and who pays, and the signs that a nursing home may be the better fit.

• Nursing home star ratings, explained

  How CMS builds the overall star from inspections, staffing and quality measures, with the live national spread of ratings.

Last updated October 31, 2026. Figures about nursing homes on this page come from the CMS Provider Data Catalog, October 2026, and update when CMS releases new data. Rules and dollar amounts are from the government sources listed above and can change; check them before you rely on them. Not medical, legal or financial advice. Nursing Homes In Each State is independent and not affiliated with CMS or Medicare. About the data · Report an error.