If you or a loved one might need nursing home care, the cost is probably your biggest worry. Nursing homes are expensive. Very expensive. And the question everyone asks is: does Medicare cover nursing home care?
The honest answer: Medicare covers only short-term skilled nursing care. It does NOT cover long-term nursing home care. This surprises most people and it’s one of the biggest gaps in Medicare.
This guide explains exactly what Medicare covers, what it doesn’t, and how to pay for long-term care.
What Medicare Covers in a Nursing Home
Medicare Part A covers care in a skilled nursing facility (SNF) — but only under specific conditions and for a limited time.
Medicare covers skilled nursing facility care when ALL of these are true:
- You had a hospital stay of at least 3 consecutive days (not counting the discharge day)
- You enter the skilled nursing facility within 30 days of leaving the hospital
- You need skilled care — like skilled nursing, physical therapy, or occupational therapy
- A doctor orders the care
What “skilled care” means:
- A registered nurse providing wound care, IV medications, or injections
- Physical therapy to help you recover from surgery or illness
- Occupational therapy to relearn daily activities
- Speech therapy
“Skilled” means you need a trained medical professional. If you only need help with eating, bathing, dressing, and walking — that’s custodial care, not skilled care. Medicare does NOT cover custodial care.
How Long Does Medicare Cover Skilled Nursing?
Medicare covers up to 100 days per benefit period in a skilled nursing facility. But the cost to you changes during that time:
- Days 1-20: Medicare pays 100%. You pay $0.
- Days 21-100: You pay $217 per day in 2026. Medicare pays the rest.
- After day 100: Medicare pays nothing. You pay everything.
Let’s do the math on days 21-100:
If you stay 100 days:
- Days 1-20: $0
- Days 21-100 (80 days × $217): $17,360
- Total you pay: $17,360
That’s a lot of money. This is why having a Medigap plan matters. Medigap Plan G covers the skilled nursing facility coinsurance ($217/day). With Plan G, your cost for all 100 days would be $0.
What Medicare Does NOT Cover
This is the critical part most people don’t understand until it’s too late.
Medicare does NOT cover long-term nursing home care.
If you need to live in a nursing home permanently because you can no longer care for yourself, Medicare will not pay for it. This includes:
- Custodial care — help with bathing, dressing, eating, toileting, and moving around
- Room and board for long-term stays
- Assisted living facilities — Medicare does not cover assisted living at all
- Memory care units for Alzheimer’s or dementia — Medicare does not cover long-term memory care
- Any stay beyond 100 days in a skilled nursing facility
The average nursing home costs $8,000 to $10,000 per month for a semi-private room. That’s $96,000 to $120,000 per year. Without coverage, this can drain a lifetime of savings in just a few years.
How to Pay for Long-Term Nursing Home Care
If Medicare doesn’t cover long-term care, how do people pay? Here are the options:
Option 1: Medicaid
Medicaid is the number one payer of long-term nursing home care in America. It covers:
- Room and board
- Custodial care
- Medical care
- All the things Medicare doesn’t cover
But there’s a catch: You must have very limited income and assets to qualify for Medicaid nursing home coverage. In most states:
- Your income must be below approximately $2,829 per month (varies by state)
- Your countable assets must be below approximately $2,000 (your home, one car, and personal belongings usually don’t count)
Many people “spend down” their savings to qualify for Medicaid. This means they pay for care out of pocket until their assets are low enough to qualify.
Important: Each state has different Medicaid rules for nursing home coverage. Contact your state Medicaid office to understand the rules in your state.
Option 2: Long-Term Care Insurance
If you planned ahead, long-term care insurance covers nursing home costs. These policies pay a daily or monthly benefit toward nursing home, assisted living, or home care.
The problem: Long-term care insurance is expensive and must be purchased before you need it. If you’re already in poor health, you likely can’t buy a policy. Premiums range from $2,000 to $5,000+ per year depending on your age and coverage level.
If you already have a long-term care insurance policy, review it carefully. Know your daily benefit amount, elimination period, and benefit period.
Option 3: Pay Out of Pocket
Many people pay for nursing home care from their savings, retirement accounts, and home equity. Given the cost of $8,000 to $10,000+ per month, this option can deplete savings quickly.
Strategies to help:
- Selling the family home to fund nursing home care
- Reverse mortgage — converts home equity to cash while allowing a spouse to remain in the home
- Annuities designed for long-term care funding
- Veterans benefits (see below)
Option 4: Veterans Benefits
If you or your spouse is a veteran, the VA offers several programs:
- VA nursing home care — available to eligible veterans, often at no cost
- Aid and Attendance benefit — provides up to $2,431 per month (2026) for veterans or surviving spouses who need help with daily activities
- Community Living Centers — VA-run nursing facilities
Contact your local VA or call 1-800-827-1000 to find out what you qualify for.
Option 5: Medicare Advantage Special Needs Plans
Some Medicare Advantage Special Needs Plans (SNPs) are designed specifically for people in nursing homes. These plans coordinate your Medicare and Medicaid benefits and may offer additional services.
Ask your nursing home social worker about Institutional Special Needs Plans (I-SNPs) available in your area.
Skilled Nursing Facility vs Nursing Home: What’s the Difference?
People use these terms interchangeably, but they’re different:
Skilled nursing facility (SNF):
- Provides short-term medical care and rehabilitation
- You’re there to recover from a hospital stay
- Medicare covers up to 100 days
- Goal: get you well enough to go home
Nursing home (long-term care):
- Provides ongoing custodial care for people who can’t live independently
- You live there permanently or for an extended period
- Medicare does NOT cover this
- Medicaid, long-term care insurance, or private pay covers this
Many facilities are BOTH — they have skilled nursing beds and long-term care beds in the same building. Make sure you understand which type of care you’re receiving and how it’s being billed.
The 3-Day Hospital Stay Rule
This rule trips up a lot of people. To qualify for Medicare-covered skilled nursing care, you must have a qualifying hospital stay of at least 3 consecutive days.
What counts:
- The day you’re admitted as an inpatient counts
- The discharge day does NOT count
- So you effectively need to stay 3 midnights in the hospital
What does NOT count:
- Time spent in the emergency room before being admitted
- Time spent under “observation status” — this is the big one
The Observation Status Problem
Some hospitals place patients under “observation status” instead of formally admitting them as inpatients. You may be in a hospital bed, wearing a hospital gown, receiving treatment — but technically you’re not “admitted.”
If you’re under observation status, that time does NOT count toward your 3-day requirement. This means you could spend 4 days in a hospital under observation and still not qualify for Medicare-covered skilled nursing care.
What to do:
- Ask your hospital: “Am I admitted as an inpatient or am I under observation?”
- If you’re under observation, ask the doctor to change your status to inpatient
- If they won’t, you have the right to receive a written notice called the Medicare Outpatient Observation Notice (MOON)
- You can appeal an observation status determination
This is one of the most confusing and frustrating parts of Medicare. If you or a loved one is in the hospital and might need nursing care afterward, ask about your admission status immediately.
Planning Ahead for Long-Term Care
The best time to plan for long-term care is before you need it. Here are steps to take now:
1. Talk about it as a family. Discuss what would happen if you or your spouse needed long-term care. Where would you want to live? How would you pay for it?
2. Look into long-term care insurance. If you’re under 65 and in good health, long-term care insurance is still an option. Compare policies from multiple companies.
3. Understand Medicaid planning. An elder law attorney can help you structure your assets to qualify for Medicaid when needed. This is legal and common. Start planning at least 5 years before you might need care — Medicaid looks back 5 years at asset transfers.
4. Consider your home equity. Your home may be your largest asset. Explore options like reverse mortgages or home equity loans that could fund care.
5. Check veterans benefits. If you or your spouse served in the military, VA benefits could provide significant help. Don’t overlook this resource.
6. Visit facilities in your area. Don’t wait until there’s an emergency. Visit nursing homes and assisted living facilities now so you know what’s available and what they cost.
Frequently Asked Questions
Does Medicare cover assisted living? No. Medicare does not cover assisted living facilities. You pay out of pocket, through long-term care insurance, or through Medicaid (in some states).
Does Medicare cover memory care for Alzheimer’s? Medicare covers short-term skilled nursing after a hospital stay, but not long-term memory care. Medicaid covers long-term memory care for people who qualify financially.
Can my spouse keep the house if I go to a nursing home on Medicaid? In most states, yes. Medicaid allows your spouse to keep the family home, one car, and a certain amount of assets. Rules vary by state — consult an elder law attorney.
What if I can’t afford a nursing home and don’t qualify for Medicaid? Contact your local Area Agency on Aging at eldercare.acl.gov or call 1-800-677-1116. They can help you find resources. Also check if you qualify for VA benefits.
Does Medicare cover home health care instead of a nursing home? Yes. Medicare covers home health care at $0 if you’re homebound and need skilled care. Many people choose home health care to avoid or delay nursing home placement.
How long can you stay in a nursing home on Medicare? Up to 100 days per benefit period in a skilled nursing facility. After 100 days, Medicare stops paying. Long-term stays beyond 100 days are not covered by Medicare.
What to Do Right Now
- If a loved one is in the hospital, ask immediately: “Are they admitted as an inpatient?” Make sure they have a qualifying 3-day stay before assuming Medicare will cover nursing care.
- If you’re considering nursing home care, contact your state Medicaid office to understand the financial requirements.
- If you’re planning ahead, talk to an elder law attorney about Medicaid planning. Start at least 5 years before you might need care.
- If you’re a veteran or veteran’s spouse, call the VA at 1-800-827-1000 to ask about nursing home and Aid and Attendance benefits.
- Consider home health care as an alternative. Medicare covers it at $0 and you stay in your own home.
- If cost is overwhelming, call your local Area Agency on Aging at 1-800-677-1116. They help families navigate these decisions every day.
Long-term care is one of the biggest financial challenges in retirement. Medicare doesn’t cover it — but knowing that now gives you time to plan. The worst thing you can do is wait until there’s an emergency. Start the conversation today.