Medicare pays for up to 100 days of nursing home care per benefit period, and only under specific conditions. The first 20 days come at no cost to you. Days 21 through 100 carry a daily coinsurance of $217 in 2026. After day 100, Medicare pays nothing. That ceiling catches many families off guard, because Medicare’s nursing home benefit is designed for short-term skilled recovery, not the long-term custodial stays most people picture.
What Medicare Actually Covers in a Nursing Home
Medicare draws a hard line between skilled care and custodial care, and the difference decides everything.
Skilled care means services that require trained professionals: wound care, IV medications, physical therapy, occupational therapy, or speech therapy. If you need a registered nurse to manage treatment or a physical therapist to help you regain mobility after a hip replacement, that qualifies under Medicare Part A.
Custodial care is the day-to-day help most people associate with a nursing home: bathing, dressing, eating, moving around. Medicare does not cover custodial care, no matter how long you need it or where you receive it. A person can live in a nursing home for years needing round-the-clock help with daily tasks, and Medicare will not pay anything toward it.
One point worth clearing up: your condition does not have to be improving. Skilled nursing or therapy is covered when it’s needed to maintain your current condition or slow further decline, as long as the care genuinely requires professional expertise. A denial based only on “no improvement potential” conflicts with Medicare policy.
What You Have to Qualify For
Four conditions must all be true before Medicare pays for a skilled nursing facility (SNF) stay:
- You spent at least three consecutive days as a hospital inpatient, not counting the discharge day.
- A doctor has ordered daily skilled nursing or rehabilitation services.
- The nursing home is certified by Medicare.
- You enter the facility within 30 days of leaving the hospital.
Miss any one of them, and Medicare pays nothing. You could be responsible for the full cost starting day one.
The Observation Status Problem
The three-day hospital rule is where most claims break down. Time spent in the hospital under “observation status” doesn’t count toward the three-day inpatient requirement, even if you sleep in a hospital bed for several nights. Observation is classified as outpatient care. A patient can spend four days in a hospital room, receive treatment around the clock, and still not qualify, because none of those days counted as inpatient.
Hospitals must give you a written Medicare Outpatient Observation Notice (MOON) if you’ve been under observation for more than 24 hours. It has to be delivered no later than 36 hours after observation services begin. If you receive one, your inpatient clock has not started. Ask about your admission status early, and keep asking. If you were admitted as an inpatient and later reclassified to observation, you can appeal that change.
Cost Breakdown by Day
Once you qualify, Part A splits your SNF stay into three tiers within each benefit period:
- Days 1–20: Medicare covers the full cost. You pay $0.
- Days 21–100: You owe $217 per day in 2026. Across the full 80-day stretch, that’s up to $17,360 out of pocket.
- After day 100: Medicare pays nothing.
Before any of that, you also have to meet the Part A inpatient hospital deductible, which is $1,736 per benefit period in 2026. That deductible applies to your qualifying hospital stay, not the nursing home itself, but it adds to the total bill you’ll face heading into an SNF admission.
When the 100 Days Reset
A benefit period starts the day you’re admitted as an inpatient to a hospital or SNF. It ends after you’ve gone 60 consecutive days without inpatient hospital care or skilled nursing facility care. Once it ends, a new one begins the next time you’re admitted, and the 100-day SNF clock resets. There’s no lifetime limit on benefit periods.
The trade-off: a new benefit period brings a new $1,736 Part A deductible and a new three-day qualifying hospital stay before SNF coverage can begin again.
A different rule applies to short gaps. If you leave an SNF and return within 30 days, you don’t need another three-day hospital stay. Your remaining covered days from the current benefit period pick up where they left off. The same is true if you stop receiving skilled care while still in the facility and restart within 30 days.
If You’re on Medicare Advantage
Everything above describes Original Medicare. If you’re enrolled in a Medicare Advantage plan (Part C), the rules can differ. Many plans waive the three-day prior hospitalization requirement, which removes the biggest eligibility hurdle. But plans may require you to use an in-network facility or get prior authorization before admission, and out-of-pocket costs may not match Original Medicare’s coinsurance structure. Check your plan’s evidence of coverage document, or call the plan directly, before an admission.
What to Do If Coverage Ends Early
If a facility tells you Medicare coverage is ending, you can appeal. The facility must give you a written Notice of Medicare Non-Coverage at least two days before it plans to stop covered services. That notice triggers your right to a fast appeal through a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO).
To keep coverage running during the appeal, contact the BFCC-QIO by noon the day before the termination date on your notice. The reviewer requests information from your provider and issues a decision by close of business the following day. Miss the noon deadline and you can still appeal, but you may owe for care during the review. The phone number for your area’s BFCC-QIO is on the notice.
After Medicare Runs Out
Once the 100 days are used up, or Medicare determines you no longer need skilled care, the financial picture changes fast. A semi-private nursing home room averages about $308 per day nationally, or roughly $112,000 per year.
A few things can soften that:
Medigap. If you have Original Medicare and a Medigap policy, it may cover part or all of the $217 daily coinsurance for days 21–100. Plans A, B, C, D, F, G, M, and N cover the SNF coinsurance in full. Plans K and L cover it at 50% and 75%. Medigap doesn’t work with Medicare Advantage.
Part B services. Even after Part A stops, Part B may keep covering certain medical services delivered in a nursing home: physician visits, nurse practitioner services, dialysis, some chemotherapy, CT scans, radiation therapy. Part B still doesn’t cover the room, board, or custodial care.
Medicaid. Medicaid is the primary payer for long-term nursing home care in the U.S., and unlike Medicare, it covers custodial care. Eligibility depends on strict income and asset limits that vary by state. Most states require a single applicant’s countable assets to be below roughly $2,000 to $33,000, along with income below a set monthly threshold. Medicaid also uses a look-back period, typically 60 months, during which past asset transfers can create a penalty period of ineligibility. Families who wait until admission to think about Medicaid planning often find that financial decisions made years earlier now cause problems. An elder law attorney is worth consulting well before care is needed.
Other sources. Long-term care insurance, if bought in advance, can pay for what Medicare and Medicaid don’t. Veterans with service-connected disabilities or other qualifying criteria may be eligible for VA-funded nursing home care through Community Living Centers or contracted community nursing homes. Private savings and home equity fill in the rest, though a stay lasting years can drain even substantial savings at over $100,000 annually.