When the time comes to transition to nursing home care, paying for it is often a concern for families. Many people mistakenly believe Medicare will cover the entire cost of long-term nursing home care but are unpleasantly surprised to discover Medicare’s coverage restrictions.
In this guide, we’ll explore what Medicare does and does not cover and what expenses you can expect when you or a loved one is facing a nursing home stay.
[READ: How Do I Know When I’m Eligible for Medicare?]
What Nursing Home Costs Does Medicare Cover?
Medicare does not cover long-term stays at a nursing home or skilled nursing facility (SNF). However, Medicare Part A (hospital insurance) covers short-term stays of up to 100 days in an SNF, typically following a hospital discharge, if eligibility requirements are met.
Services covered include:
— Ambulance transportation
— A semi-private room
— Dietary counseling
— Meals
— Medical supplies and equipment
— Medical social services, including counseling
For long-term stays at an SNF, while Medicare will not cover most costs, they may provide some benefits related to your health care needs only. 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
“Medicare may cover physical, occupational and speech therapies in a skilled nursing setting if they are part of a prescribed plan of care,” adds 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 says. Always check with your plan to determine which benefits you are entitled to.
[READ: How to Pay for Nursing Home Costs.]
Custodial vs. Skilled Care: What Medicare Does Not Cover
Medicare does not cover custodial care, or nonmedical assistance with activities of daily living (ADLs), such as grooming, dressing or eating. It also stops paying for an SNF stay once you no longer need daily skilled medical care or your benefit period ends, even if you continue living in the same facility.
Understanding the difference between custodial care and skilled care is important because Medicare coverage is based on the type of care a person needs.
At a glance: Custodial care vs. skilled care
| Skilled Care | Custodial Care | |
| Type of care | Medical treatment and rehabilitation | Personal assistance and daily support |
| Who provides it | Licensed nurses or therapists | Care aides or personal caregivers |
| Purpose | Recovery, treatment or monitoring of a medical condition | Help with ADLs |
| Examples | Wound care, injections, physical therapy and medical monitoring | Bathing, dressing, eating, toileting and mobility help |
| Typical duration | Short-term | Often long-term or ongoing |
| Medicare coverage | Yes, if eligibility rules are met | No, when only custodial care is needed |
[READ: Nursing Homes vs. Assisted Living.]
How to Qualify for Medicare Skilled Nursing Care
To qualify for Medicare coverage for skilled nursing care, you must fulfill all of the following requirements, according to Medicare.gov:
— 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 and not including if you were admitted for observation).
— 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 SNF.
[READ: What Qualifies a Patient for Skilled Nursing Care?]
Medicare Nursing Home Coverage: Days and Costs (1–100)
Your portion of the bill for a short-term SNF stay depends on the length of time you are there and your specific Medicare plan.
2026 Medicare cost breakdown of skilled nursing care
| Duration of Time in a Skilled Nursing Facility | What You Pay With Original Medicare |
| Days 1-20 | $0 (after you meet the deductible of $1,736 in 2026) |
| Days 21-100 | $217 per day in 2026 |
| Day 101 and beyond | 100% of costs |
Does Medigap cover skilled nursing facility stays?
Some Medigap plans, or supplemental insurance that can be paired with original Medicare, may cover an SNF stay. Medigap plans C through N, for instance, do have some coverage for SNF stays, but Medigap Plan A and Plan B do not. Check with your plan.
Does Medicare Advantage cover skilled nursing facility stays?
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,” confirms 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.
What if you don’t qualify for Medicare coverage of nursing home care?
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 is $9,581 per month for a semi-private room and $10,798 per month for a private room, according to CareScout’s Cost of Care Survey.
How to Pay for Long-Term Nursing Home Care
There are other ways to pay for nursing home care, including:
— Long-term care insurance. This type of insurance policy helps cover the costs of long-term care services, such as nursing homes.
— Medicaid. Eligibility requirements are state-dependent, so you will need to check with your state’s Medicaid office. According to KFF, Medicaid is the primary payer for 62% of nursing home residents. If you qualify for both Medicare and Medicaid, Medicare will be your primary insurance for medical services like visits to the doctor, hospital stays and medications, Duewel says. Medicaid, however, can help cover long-term care at nursing home.
— Self-pay. You can always pay out of pocket, but costs add up fast. Family contributions may provide a significant financial boost, 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 Department of Veterans Affairs (VA) health care before applying for VA long-term care services. For further details, check the VA Geriatrics and Extended Care page.
Comparing long-term nursing home payment options
| Funding source | Type of Coverage | Key Considerations | Best for |
| Medicaid | Long-term custodial care | Strict income and asset limits, including spend downs | Those with limited financial resources |
| Long-term care insurance | Custodial and skilled care | Policy purchased years in advance; expensive premiums | Proactive planners with sufficient income |
| Self-pay (out-of-pocket) | Custodial and skilled care | High median monthly cost | Those with significant personal savings and assets |
| Veterans benefits (e.g., Aid & Attendance) | Custodial and skilled care | Must be a qualified veteran or surviving spouse; asset limitations | Veterans who meet service and financial criteria |
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 on how to begin applying for Medicaid or provide other local options that may be readily available if you need assistance quickly.
Finding Medicare-Certified 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 is also a helpful resource. Medicare provides a list of Medicare-certified facilities on its website.
Another great resource is U.S. News’ Best Nursing Homes. 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.
Frequently Asked Questions
Bottom Line
Medicare can help pay for nursing home care, but only in limited situations. The program is designed to cover short-term, medically necessary skilled care, not long-term living or personal assistance. If you qualify, Medicare Part A covers up to 100 days in a Medicare-certified SNF following a hospital stay of at least three days. However, coverage ends once you no longer need daily skilled nursing care or your benefit period runs out, even if you remain in the same facility.
What Medicare generally does not cover is custodial care, the type of care most people eventually need in a nursing home. Because long-term stays can be costly, families often rely on other payment sources, such as Medicaid, long-term care insurance, personal savings or veterans benefits. Understanding the difference between skilled and custodial care, and planning ahead for how long-term care will be financed, can help prevent unexpected expenses and make future care decisions less stressful.
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Does Medicare Pay for Nursing Home Stays? Coverage and Costs originally appeared on usnews.com
Update 04/10/26: This story was published at an earlier date and has been updated with new information.