When the time comes to transition to nursing home care, figuring out how to pay for it is often a primary concern for families. Many people mistakenly believe Medicare will cover the entire cost of nursing home care but are unpleasantly surprised to discover Medicare’s coverage restrictions.
Does Medicare Cover Nursing Homes?
In short, no, Medicare does not pay for long-term nursing home care.
Medicare Part A (hospital insurance) is designed to pay for short-term medical needs, such as hospital stays and skilled nursing care following a hospital discharge. It does not cover ongoing nonmedical assistance, or custodial care, that helps individuals with activities of daily living.
[READ What to Do When Medicare Stops Paying for Skilled Nursing Care]
What is custodial care?
Custodial care focuses on providing support for basic personal tasks, rather than addressing specific medical conditions or treatments that are covered under skilled medical care.
Key features of custodial care include assistance with:
— Basic household chores like cleaning
— Bathing and grooming
— Dressing
— Eating
— Mobility, such as transferring from bed to chair
— Toileting
[READ: How to Advocate for an Older Loved One in the ER or Hospital]
What Does Medicare Cover?
If you need a nursing home for a short-term stay, Medicare pays for the short-term care and rehabilitation needed to treat and manage your condition for up to 100 days.
It covers the following services:
— Ambulance transportation
— A semi-private room
— Dietary counseling
— Meals
— Medical supplies and equipment
— Medical social services, including counseling
— Occupational therapy
If you are in a nursing home for a long-term stay, Medicare may provide some benefits related to your health care needs.
Depending on your situation, your plan may cover:
— Doctor and specialist visits
— Durable medical equipment, such as wheelchairs or walkers
— Prescription medications
— Preventive services, such as vaccinations or screenings
— Therapeutic services, including physical, occupational, speech and cognitive therapy
“Medicare may cover physical, occupational and speech therapies in a skilled nursing setting if they are part of a prescribed plan of care,” explains Gretchen Jacobson, vice president of the Medicare program for the Commonwealth Fund in New York City. “Therapy must be intended to improve, maintain or slow the decline of a patient’s functional ability due to a medical condition. Cognitive therapy can sometimes be covered if there’s a clear medical justification.”
Medicare Advantage plans may have further benefits, costs or requirements that you should be aware of before making any decisions, Jacobson adds.
Always check with your plan to determine which benefits you are entitled to.
Your doctor or health care provider might recommend services more often than what Medicare typically covers or suggest treatments that Medicare does not include. In these situations, you may have to cover some or all of the costs yourself. It’s important to ask questions to clarify why certain services are being recommended and to understand how much Medicare will cover.
[READ: How to Talk to Your Parents’ Doctors: Tips for Successful Communication]
Qualifying for Short-Term Care
Medicare Part A provides coverage for short-term skilled nursing home care if you meet certain eligibility criteria. According to Medicare.gov, you must fulfill all of the following requirements to qualify for Medicare Part A coverage:
— You have Part A and also have time left in your benefit period.
— You’ve had a hospital stay of at least three days (not including the day you leave the hospital).
— Your doctor determines you need daily skilled nursing care.
— You require skilled nursing services for a hospital-related medical condition (such as an infection) that was treated during your qualifying three-day inpatient hospital stay, even if it wasn’t the reason for your admission.
— You enter the facility within 30 days of leaving the hospital.
— You need skilled nursing care or therapy to maintain or improve your condition or to prevent or delay the condition from getting worse.
— Your care is in a Medicare-certified skilled nursing facility.
Paying for Care
Your portion of the bill for a short-term stay depends on the length of time you are there and if you have original Medicare or a Medicare Advantage plan. Medigap, or supplemental insurance that can be paired with original Medicare, has numerous plans, some of which may provide coverage. Medigap plans C through N, for instance, do have some coverage for skilled nursing facility stays, but Medigap Plan A and Plan B do not have skilled nursing facility benefits to help cover what original Medicare doesn’t. Check with your plan.
Under original Medicare, the cost breakdown of skilled nursing is:
| Timeline | Patient responsibility |
| First 20 days | Patients pay $0 after the deductible. |
| Days 21 to 100 | Patients pay up to $217 per day in 2026, depending on how the patient is progressing and what their care needs are over time. |
| After day 100 | Patients pay 100% of the cost of care. |
Medicare Advantage plans are required to offer at least the same coverage as original Medicare, but they may differ in areas such as costs and facility requirements. For example, some plans may charge a copayment for the first 20 days of care or require the use of in-network facilities to access benefits.
“Medicare Advantage does not have the consistent benefits original Medicare does,” says Colleen Duewel, founder and president of LionHeart Eldercare & Consulting in Falls Church, Virginia. “Be aware that Medicare Advantage benefits vary widely, depending on the plan. Many do not require the three-day stay in the hospital, but most don’t pay for 100 days of coverage.”
It’s essential to review your specific plan details to understand your benefits, costs and any applicable requirements before entering a facility.
If you need nursing home care but do not qualify under Medicare’s criteria, you are responsible for the bill minus any medical-related expenses that Medicare may cover, such as therapeutic services or prescription medication. Although it depends on factors such as where you live and what level of care you need, the median cost of a nursing home room according to Genworth and CareScout’s 2024 Cost of Care survey is $9,277 per month for a semi-private room and $10,646 per month for a private room.
There are other ways to pay for nursing home care, including:
— Long-term care insurance. Long-term care insurance is a type of insurance policy that helps cover the costs of long-term care services, such as nursing homes.
— Medicaid. To meet the financial threshold need to apply for Medicaid, you may need to pay out-of-pocket to deplete financial resources or complete a spend down, among other options. According to the Centers for Disease Control and Prevention, Medicaid is the primary payer for 62% of nursing home residents.
— Self-pay. There is always the option of paying out-of-pocket, but that can add up fast. Family contributions may provide significant financial help, and monthly income streams like Social Security benefits can help, even though they don’t cover medical care directly.
— Veterans benefits. Veterans must be enrolled in Veterans Administration health care before applying for VA long-term care services. For further details, check the VA Geriatrics and Extended Care page.
“Even if Medicaid covers nursing home costs, Medicare remains the primary insurance for medical services like doctor visits, hospital stays and medications,” Duewel says. “Medicaid helps with the long-term care portion (custodial care), while Medicare continues to manage the individual’s medical health.”
It can feel scary if you need long-term nursing home care and cannot afford it, but there are always options. Each state has different rules and care choices for those with limited or no resources, so speak with your state’s Area Agency on Aging or use the Eldercare locator to find local social services offices that can help you. They can guide you as to how to begin the process of applying for Medicaid or give you other local options that may be readily available if you need assistance quickly.
Finding Nursing Homes Near You
Your doctor is a good place to start looking for recommendations. Word-of-mouth from friends, family or other members of your community are also helpful resources. Medicare provides a list of Medicare-certified facilities on its website.
Another great resource is U.S. News’ Best Nursing Homes. In 2025, U.S. News evaluated and rated close to 15,000 nursing homes in two areas: short-term rehabilitation and long-term care. You can search for and filter results by selecting those that accept Medicare or Medicaid to help you can find the best fit for you or your loved one.
Bottom Line
Medicare pays for short-term care in a nursing home for up to 100 days, but you must fulfill certain requirements to qualify. In addition, copayments, deductibles and other costs may apply, depending on your plan.
Custodial care, meaning nonmedical help with activities of daily living, is not covered, but certain aspects of care, such as medications or visits to the doctor, may be. Check with your plan to find out what is available to you.
Nursing homes can be a significant financial burden, costing an average of $111,325 per year for a semi-private room. There are various options to help cover these costs, including long-term care insurance, out-of-pocket payments, Medicaid and VA benefits.
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Does Medicare Pay for Nursing Homes? originally appeared on usnews.com
Update 12/12/25: This story was previously published at an earlier date and has been updated with new information.