Medicare does not cover long-term nursing home stays. It only covers short-term skilled nursing care after a qualifying hospital stay, and even then, you’ll pay nothing out of pocket for just the first 20 days. After that, your daily coinsurance in 2025 is $209.50 per day through day 100. Beyond 100 days, Medicare pays nothing at all, and you’re responsible for the full cost, which averages about $308 per day nationally for a semi-private room.
Understanding these limits is critical because most nursing home care is custodial, meaning help with bathing, dressing, eating, and getting around. Medicare almost never pays for that. Here’s what the coverage actually looks like and what you can expect to spend.
What Medicare Actually Covers
Medicare Part A covers skilled nursing facility (SNF) care, not general nursing home residence. Skilled care means you need medical services like wound care with sterile dressings, IV medications, or physical and occupational therapy that requires trained professionals. If your only needs are help with daily activities like bathing or eating, Medicare won’t pay.
To qualify, you must first have a medically necessary inpatient hospital stay of at least three consecutive days. The count starts the day you’re formally admitted as an inpatient but does not include the day you’re discharged. This is where many people get caught off guard: time spent in the emergency room or under “observation status” does not count toward those three days, even if you’re physically in a hospital bed overnight. If you spend two days under observation and one day as an inpatient, you haven’t met the requirement.
Once you’re admitted to a skilled nursing facility, Medicare also requires that you need skilled services on a daily basis. For rehabilitation therapy specifically, that means at least five days per week. If your condition improves to the point where you no longer need that level of care, coverage ends regardless of how many days you’ve used.
Your Out-of-Pocket Costs Day by Day
Medicare structures SNF coverage in a single “benefit period,” which starts the day you enter the facility and resets after you’ve been out of the hospital and SNF for 60 consecutive days. Within one benefit period, the cost breakdown for 2025 looks like this:
- Days 1 through 20: $0 coinsurance. Medicare covers the full cost of your skilled nursing care.
- Days 21 through 100: You pay $209.50 per day in coinsurance. Medicare covers the rest.
- Days 101 and beyond: Medicare pays nothing. You’re responsible for the entire daily rate.
So if you use the full 100 days of coverage, your out-of-pocket cost for days 21 through 100 alone would be $16,760. That’s a significant bill, but it’s still far less than the full private-pay rate. Once you pass day 100, you’re looking at the full cost of a nursing home stay with no Medicare support.
What a Nursing Home Costs Without Medicare
The national average cost for a semi-private nursing home room is about $308 per day, or roughly $112,420 per year, based on 2024 survey data from the Federal Long Term Care Insurance Program. Private rooms cost more, and prices vary dramatically by state and region. Urban facilities in the Northeast or West Coast can run well above the national average, while rural areas in the South and Midwest tend to cost less.
These are the rates that apply once Medicare’s 100-day window closes, or if you never qualified for Medicare SNF coverage in the first place. For someone who needs long-term custodial care (the most common reason people live in nursing homes), this is the cost from day one, because Medicare was never going to cover it.
How Medigap Can Reduce Your Coinsurance
If you have Original Medicare and a Medigap (Medicare Supplement) policy, some plans will pick up part or all of the $209.50 daily coinsurance for days 21 through 100. Medigap Plans C, D, F, G, M, and N cover 100% of that coinsurance. Plan K covers 50%, and Plan L covers 75%. Plans A, B, and high-deductible versions of F and G do not cover it at all.
This can save you thousands of dollars during a skilled nursing stay, but Medigap only helps with the coinsurance portion. It does not extend coverage beyond 100 days or pay for custodial care. Once Medicare’s benefit period ends, Medigap stops paying too.
Medicare Advantage Plans Work Differently
If you’re enrolled in a Medicare Advantage plan (Part C) instead of Original Medicare, your SNF coverage terms may differ from the standard structure above. Medicare Advantage plans must cover at least what Original Medicare covers, but they set their own cost-sharing amounts. Some charge lower daily coinsurance than $209.50, while others may charge similar or slightly different rates depending on their network and plan design.
Many Medicare Advantage plans also require prior authorization before admitting you to a skilled nursing facility, and some have waived the three-day hospital stay requirement for SNF admission. Check your plan’s evidence of coverage document for the specific rules and costs that apply to you.
What Pays for Long-Term Nursing Home Care
Since Medicare only covers short-term skilled stays, people who need months or years of nursing home care typically pay through one of a few sources. Private savings and retirement income cover the cost for some families, at least initially. Long-term care insurance, if purchased years before it’s needed, can cover a significant portion of daily nursing home costs.
Medicaid is the largest payer of long-term nursing home care in the United States. Unlike Medicare, Medicaid does cover custodial care in a nursing home, but it’s a means-tested program. You generally must have very limited income and assets to qualify. Many people spend down their savings paying privately before becoming eligible for Medicaid, a process that can take months or years depending on your financial situation and your state’s eligibility rules.
Veterans may also have access to nursing home care through the VA, including both short-term and long-term options, though availability and eligibility criteria vary. For most people, planning for nursing home costs means understanding that Medicare is a short-term bridge after a hospitalization, not a solution for ongoing care.