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Does Medicare Pay for Nursing Homes?

En español | Medicare does not cover any type of long-term care, whether in nursing homes, assisted living facilities or people’s own homes.

Of course, Medicare covers medical services in these settings. But it does not pay for a stay in any long-term care facilities or the cost of any custodial care (that is, help with activities of daily life, such as bathing, dressing, eating and going to the bathroom), except for very limited circumstances when a person receives home health services through a Medicare-approved agency.

Some short-term stays qualify

Under specific, limited circumstances, Medicare Part A, which is the component of original Medicare that includes hospital insurance, does provide coverage for short-term stays in skilled nursing facilities, most often in nursing homes.

Your doctor might send you to a skilled nursing facility for specialized nursing care and rehabilitation after a hospital stay. If you had a stroke or serious injury, you could continue your recovery there.

If you’re enrolled in original Medicare, it can pay a portion of the cost for up to 100 days in a skilled nursing facility.

You must be admitted to the skilled nursing facility within 30 days of leaving the hospital and for the same illness or injury or a condition related to it.

What’s a ‘qualifying hospital stay’?

Another important rule: You must have had a “qualifying hospital stay,” meaning you were formally admitted as an inpatient to the hospital for at least three consecutive days. You cannot have been in “observation” status.

In both cases you are lying in a hospital bed, eating hospital food and being attended to by hospital doctors and nurses. But time spent under observation does not count toward the three-day requirement for Medicare coverage in a skilled nursing facility.

When you enter the hospital, ask if you are being officially admitted or for observation. If the latter, you may want to appeal to your doctor to see if you can be switched to inpatient status. Two more things to note about the three-day rule:

  • Medicare Advantage plans, which match the coverage of original Medicare and often provide additional benefits, often don’t have those same restrictions for enrollees. Check with your plan provider on terms for skilled nursing care.
  • Skilled nursing facilities are the only places that have to abide by the rule. If you’re discharged from the hospital to another kind of facility for ongoing care, such as a rehabilitation hospital, Medicare provides coverage under different rules.

If you qualify for short-term coverage in a skilled nursing facility, Medicare pays 100 percent of the cost — meals, nursing care, room, etc. — for the first 20 days. For days 21 through 100, you bear the cost of a daily copay, which was $170.50 in 2019.

If you remain in the skilled nursing facility longer than 100 days, you’re responsible for the full cost unless you have additional insurance, such as a Medigap policy, that covers it.

Who pays for long-term care?

Medicare doesn’t pay anything toward the considerable cost of staying in a nursing home or other facility for long-term care.

So who or what does? Here are some options.

  • Private pay: Many individuals and families simply pay out of pocket or tap assets such as property or investments to finance their own or a loved one’s nursing home care. If they use up those resources, Medicaid may become an option.
  • Long-term care insurance: Some people have long-term care insurance that might pay, depending on the terms of their policies.
  • The VA: Military veterans may have access to long-term care benefits from the U.S. Department of Veterans Affairs.
  • Medicaid: The state and federal health care program that provides coverage to low-income people who qualify pays a considerable portion of America’s nursing home bills. Medicaid eligibility varies by state but requires strictly limited income and financial assets.

Many Americans who are in need of long-term care apply after spending down their resources to the point of qualifying. Contact your State Health Insurance Assistance Program for information on eligibility.

Editor's note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.


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