Paying for Care
Does Medicare Cover Nursing Homes? The 100-Day Rule Explained
Does Medicare Cover Nursing Home Care?
Medicare covers nursing home care only as short-term skilled care after a qualifying hospital stay: up to 100 days per benefit period in a Medicare-certified skilled nursing facility, with $0 a day for days 1 to 20 and $217 a day for days 21 to 100 in 2026. It doesn't pay for long-term custodial care, which is help with bathing, dressing and eating. Most families pay for that privately or through Medicaid.
Medicare covers nursing home care only in one situation: a short stay for daily skilled nursing or therapy after a hospital stay. It never pays for long-term care in a nursing home, the help with bathing, dressing, eating and getting around that most residents need month after month. If your parent is leaving the hospital and needs rehab, Medicare may pay for up to 100 days. If your parent needs ongoing care, someone else pays: your family, Medicaid, the VA or long-term care insurance.
This guide explains the rules Medicare uses, what a stay costs in 2026, the observation-status problem that catches many families, and what happens when Medicare stops paying.
Does Medicare Cover Nursing Home Care? Skilled Care Yes, Long-Term Care No
Medicare draws a hard line between two kinds of care that can happen in the same building.
Skilled nursing facility care is nursing and therapy that only licensed professionals can safely give, such as intravenous medications, wound care or physical therapy after a hip fracture. Medicare Part A covers it for a limited time when the rules below are met. Medicare calls the setting a skilled nursing facility, and many nursing homes run a skilled unit inside the same building.
Long-term care, also called custodial care, is help with daily activities for someone with a chronic illness or disability. Medicare.gov is blunt about it: Medicare doesn’t pay for long-term care, and you pay all costs for it unless another program covers it. That’s true whether the care happens at home, in assisted living or in a nursing home.
So the question to ask isn’t “is this a nursing home?” but “does my parent need daily skilled care, and did a qualifying hospital stay come first?”
Almost every nursing home takes Medicare. CMS lists 14,443 of the 14,690 nursing homes it tracks as Medicare certified (data from August 2026). You can search them on the nursing home finder or your state page.
The Rules for a Medicare-Covered Skilled Nursing Stay
Your parent must meet every one of these conditions, according to Medicare.gov:
- A qualifying inpatient hospital stay. At least 3 days in a row as a formally admitted inpatient. The count starts the day of admission and doesn’t include the day of discharge.
- Entry within about 30 days. Your parent generally has to enter the skilled nursing facility within 30 days of leaving the hospital.
- A doctor’s order for daily skilled care. A doctor or other provider decides your parent needs skilled nursing or therapy every day, given by or under the supervision of skilled staff.
- Care related to the hospital stay. The skilled care is for a condition treated during the hospital stay (even if it wasn’t the reason for admission), or for a new condition that started during the skilled nursing stay.
- A Medicare-certified facility. The facility must be certified by Medicare.
- Days left in the benefit period. Part A allows 100 days of skilled nursing care in each benefit period.
Two details help families more than they expect.
Improvement isn’t required. Medicare.gov says skilled care can be to improve or maintain your current condition, or to prevent or delay it from getting worse. A facility shouldn’t end coverage only because your parent has stopped making progress, as long as daily skilled care is still needed.
The 30-day window works in both directions. If your parent leaves the skilled nursing facility and goes back to the same or another one within 30 days, no new 3-day hospital stay is needed. The same applies if skilled care stops and restarts within 30 days.
Medicare Advantage Plans Can Use Different Rules
About the 3-day stay, Medicare.gov notes that Medicare Advantage plans may waive it, and so may doctors in an Accountable Care Organization with a “Skilled Nursing Facility 3-Day Rule Waiver.” Advantage plans may also charge copayments in the first 20 days. If your parent has an Advantage plan, call the plan before discharge and ask which skilled nursing facilities are in its network.
Observation Status: Why a Hospital Stay May Not Count
This is the rule that surprises the most families. A person can spend three nights in a hospital bed and still not have a qualifying stay.
Hospitals sometimes keep patients as outpatients “under observation” while they decide whether to admit them. Medicare.gov says time under observation or in the emergency room before admission doesn’t count toward the 3 inpatient days, even if your parent stays overnight. Only the days after a formal inpatient admission count.
What to do:
- Ask every day. Ask the nurse or doctor, “Is my mother an inpatient or an outpatient under observation?” Write down the answer and the date of any admission order.
- Ask early about discharge. If your parent will need rehab, tell the hospital discharge planner as soon as possible, and ask whether Medicare will cover the skilled nursing stay.
- Ask about other options. If the stay doesn’t qualify, Medicare.gov suggests asking whether care at home through home health, or another program such as Medicaid or veterans’ benefits, could cover the care.
- Appeal a status change. If your parent was admitted as an inpatient and the hospital later changed the status to outpatient getting observation services, you may be able to appeal the denial of Part A coverage. Medicare.gov says these appeals reach back to hospital stays in January 2009.
Medicare Certified: Nursing Homes by State
CMS Care Compare lists 14,443 nursing homes in this group (medicare certified) across 53 states and territories, data from August 2026. Pick a state for its nursing homes, cities and senior care rules.
What You Pay for a Skilled Nursing Stay in 2026
Original Medicare’s costs depend on how long your parent stays. These are the 2026 amounts for each benefit period from Medicare.gov.
| Days in the skilled nursing facility | What your parent pays in 2026 |
|---|---|
| Days 1 to 20 | $0 a day, after the $1,736 Part A deductible (not owed again if already paid for the hospital stay in the same benefit period) |
| Days 21 to 100 | $217 a day |
| Day 101 and after | All costs |
The coinsurance adds up fast. If your parent uses all 80 days from day 21 to day 100, the coinsurance comes to $17,360. Many people have help with it:
- Medigap. Several Medicare Supplement plans cover the skilled nursing coinsurance. Plan K pays 50% and Plan L pays 75%, and Medicare.gov’s comparison chart shows which plans pay it in full.
- Medicaid. Medicare.gov notes that most health care costs are covered if you qualify for both Medicare and Medicaid.
- Retiree or employer coverage may also pay part of it. Check the plan booklet.
How Benefit Periods Reset
A benefit period starts the day your parent is admitted as an inpatient to a hospital or skilled nursing facility. It ends after 60 days in a row with no inpatient hospital care and no skilled care in a skilled nursing facility. A later admission then starts a new benefit period with a new deductible and a new set of 100 days. Medicare sets no limit on the number of benefit periods.
What Medicare Covers Inside a Skilled Nursing Facility
During a covered stay, Medicare.gov lists these services:
- a semi-private room (shared with another resident);
- meals and dietary counseling;
- skilled nursing care;
- physical, occupational and speech-language therapy, when needed to meet your parent’s health goals;
- medical social services;
- medications;
- medical supplies and equipment used in the facility;
- ambulance transportation to the nearest supplier of services the facility doesn’t offer, when other transportation would endanger your parent’s health.
A private room, a personal phone or TV, and personal care items are not on the list. Ask the admissions office which charges are extra before your parent arrives.
When Medicare Stops Paying and Long-Term Care Begins
Coverage ends when any rule stops being met: your parent no longer needs daily skilled care, or reaches day 100 of the benefit period. If your parent still can’t live safely at home, the stay often continues as long-term care, and the bill changes.
From that day, the nursing home charges its private rate unless another payer steps in. These are the options:
| Who pays | What it can cover | Where to start |
|---|---|---|
| Medicare | Short-term skilled care only, up to 100 days per benefit period | This guide |
| Medicaid | Long-term nursing home care for people who meet the state’s income and asset limits | Medicaid nursing home eligibility |
| VA | Nursing home care, State Veterans Homes and Aid and Attendance for eligible veterans | VA long-term care |
| Long-term care insurance | Daily benefits under the policy’s terms, after any waiting period | Long-term care insurance |
| Private pay | Anything, at the facility’s rate | How to pay for a nursing home |
Medicaid rules are set state by state. CMS lists 14,151 nursing homes as Medicaid certified (data from August 2026), but certification doesn’t mean a home has a Medicaid bed open. The Medicaid long-term care checker shows the 2026 income and asset limits for your parent’s state and marital status.
If you think your parent may need Medicaid soon, start the application early. A Medicaid caseworker or an elder law attorney can explain how your state treats a spouse at home, and the legal and financial planning guide covers the documents to prepare.
Does Medicare Pay for Assisted Living, Home Care or Respite Care?
Families often ask these questions together, so here are Medicare’s answers in one place.
Assisted living. No. Medicare doesn’t pay for room, board or personal care in assisted living, because that’s long-term care. Medicare still covers your parent’s doctor visits, hospital care and prescriptions while living there. Many states help pay for assisted living services through Medicaid waivers.
Care at home. Partly. Medicare covers home health care when your parent is homebound and needs part-time or intermittent skilled services, and covered home health services cost $0. It doesn’t pay for 24-hour care at home, meal delivery or homemaker help when that’s the only care needed. The home health vs home care guide explains the difference.
Respite care. Only inside hospice. Medicare covers short inpatient respite care for a person receiving the hospice benefit, so the family caregiver can rest, and your parent may pay 5% of the Medicare-approved amount. Outside hospice, Medicare doesn’t pay for respite. The respite care guide lists other ways to pay.
Hospice in a nursing home. Medicare covers hospice care for a person with a life expectancy of 6 months or less, but not the nursing home’s room and board.
How to Choose a Skilled Nursing Facility Before Discharge
Discharge planners often hand families a list and ask for a choice within a day. A little preparation helps.
- Check the CMS star ratings. Medicare’s Care Compare rates every certified nursing home. CMS rates 5,766 homes 4 or 5 stars overall (data from August 2026). The star ratings guide explains what each rating measures.
- Compare a short list. The nursing home comparison tool puts staffing hours, turnover, inspection results and fines side by side for up to three homes.
- Ask about long-term beds. If your parent may need to stay after Medicare ends, ask whether the home accepts Medicaid and whether your parent could stay in the same building.
- Look at city lists. Larger cities have dozens of choices, such as the nursing homes in Houston or nursing homes in Chicago.
- Visit if you can. The nursing home checklist lists what to look for in person.
If a skilled nursing facility tells your parent that Medicare will stop paying, ask for the notice in writing and ask how to appeal. The state’s Long-Term Care Ombudsman can help, and the residents’ rights guide explains how. For help finding local aging services, call the Eldercare Locator at 1-800-677-1116.
Frequently Asked Questions
Does Time in the Emergency Room Count Toward the 3-Day Stay?
No. Medicare.gov says time at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3 inpatient days, even if you stay overnight. The count starts the day you're formally admitted as an inpatient and doesn't include the day you leave.
Can My Parent Get Another 100 Days of Skilled Nursing Care?
Yes, once a new benefit period starts. A benefit period ends when your parent hasn't had inpatient hospital care or skilled care in a skilled nursing facility for 60 days in a row. A later hospital admission then starts a new benefit period with new days available, and Medicare sets no limit on the number of benefit periods.
Does a Medicare Advantage Plan Cover Skilled Nursing the Same Way?
Not always. Medicare Advantage plans may waive the 3-day hospital stay requirement, and they may charge copayments during the first 20 days, when Original Medicare charges $0. Call the plan before the hospital discharge to ask about its rules and which facilities are in its network.
Will Medicare Pay for a Nursing Home if My Parent Is on Hospice?
Medicare's hospice benefit covers the hospice care itself, but Medicare.gov says you may have to pay for room and board if you live in a facility like a nursing home and choose hospice. The hospice care guide explains the benefit.
What if Medicare Coverage Was Denied Because of Observation Status?
If the hospital admitted your parent as an inpatient and then changed the status to outpatient getting observation services, Medicare.gov says you may be able to appeal the denial of Part A coverage, for hospital stays back to January 2009. If the appeal is approved, Part A may cover the hospital stay and the skilled nursing facility care that followed.
Does Medicare Pay for Nursing Home Care for Dementia?
Not for long-term care. A diagnosis of dementia doesn't change Medicare's rules: it covers a skilled nursing stay after a qualifying hospital stay when daily skilled care is needed, but not ongoing supervision or help with daily activities. The dementia care options guide covers the settings and who pays for each.
More on Paying for Care
- Medicaid for Nursing HomesIncome and asset limits, spousal protections and the look-back period
- Medicaid WaiversHome and community-based services waivers by state
- VA Long-Term CareVA nursing home care, state veterans homes and pension benefits
- Long-Term Care InsuranceWhat policies cover, partnership programs and alternatives
- Paying for a Nursing HomeMedicare, Medicaid, VA, insurance and private pay compared
- Memory CareSecured dementia care in assisted living and nursing homes, state rules and how to pay
This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.