Medicare covers skilled nursing facility care, but only under specific conditions and for a limited time. The most important requirement: you typically need a qualifying hospital stay of at least 3 consecutive inpatient days before Medicare will pay for any nursing home care. Understanding the full set of rules can save you thousands of dollars and prevent unexpected denials.
The 3-Day Hospital Stay Requirement
Before Medicare will cover a skilled nursing facility stay, you must have been admitted as an inpatient to a hospital for at least 3 days in a row. The count starts on the day you’re admitted but does not include the day you’re discharged. So if you’re admitted on a Monday, Tuesday counts as day two, Wednesday as day three, and you could be discharged Thursday and still qualify.
There’s a critical distinction here that catches many people off guard. If you’re placed under “observation status” in the hospital, those days do not count toward the 3-day requirement, even if you spent multiple nights in a hospital bed. Observation is technically outpatient care. Always ask the hospital whether you’ve been formally admitted as an inpatient, because this single detail determines whether Medicare will cover your nursing facility stay at all.
Once you leave the hospital, you generally must enter the skilled nursing facility within 30 days for Medicare to cover it.
What Medicare Actually Requires
A qualifying hospital stay alone isn’t enough. Medicare also requires that a doctor certify you need daily skilled care. This means care that can only be provided by or supervised by licensed nursing or therapy staff, such as intravenous medications, wound care, or physical therapy. The skilled care must relate to a condition treated during your hospital stay, or to a new condition that developed while you were receiving nursing facility care for that original condition.
The goal of the care also matters. Medicare covers skilled services meant to improve your condition, maintain your current level of function, or prevent your condition from getting worse. If all you need is help with daily activities like bathing, dressing, eating, or getting around, that’s considered custodial care, and Medicare does not pay for it. Most nursing home care is custodial care, which is why many people are surprised to learn Medicare won’t cover a long-term stay.
How Long Medicare Pays
Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility, but the coverage isn’t the same for all 100 days.
- Days 1 through 20: Medicare pays in full. You owe nothing beyond what you’ve already paid for your Part A deductible.
- Days 21 through 100: You pay a daily coinsurance of $209.50 (in 2025). That adds up to $16,760 if you use all 80 of those days.
- After day 100: Medicare stops paying entirely. You’re responsible for the full cost.
A benefit period begins when you’re admitted to a hospital and ends when you’ve been out of a hospital or skilled nursing facility for 60 consecutive days. After that 60-day gap, a new benefit period starts, and the 100-day clock resets. In practice, most Medicare-covered nursing facility stays are far shorter than 100 days. Once your medical team determines you no longer need daily skilled care, Medicare coverage ends regardless of how many days remain.
How the Admission Process Works
The process typically starts while you’re still in the hospital. A hospital discharge planner or social worker will assess whether you need skilled nursing care after discharge. If you do, they’ll help identify facilities that accept Medicare and have available beds. Your doctor must provide a certification at the time of admission (or shortly after) confirming that you need skilled care on a daily basis as an inpatient.
After admission, a doctor must recertify your need for continued care by the 14th day. After that, recertification happens at least every 30 days. Each time, the facility and your physician are confirming that you still require the level of skilled care Medicare demands. If at any point the determination is that you’ve plateaued or no longer need skilled services, your Medicare-covered stay ends.
You have the right to choose which Medicare-certified facility you go to, though availability and location may limit your options in practice. You can search for Medicare-certified nursing homes through Medicare’s Care Compare tool online.
Medicare Advantage Plans Work Differently
If you have a Medicare Advantage plan instead of Original Medicare, the rules shift in important ways. Nearly all Medicare Advantage plans require prior authorization for skilled nursing facility stays. This means the plan must approve your admission before you go, or you risk having the claim denied.
Medicare Advantage plans also typically limit you to facilities within their provider network. Going to an out-of-network nursing home could mean higher costs or no coverage at all. Some Medicare Advantage plans have waived the 3-day hospital stay requirement in certain situations, but this varies by plan, so check your specific benefits.
If you’re on a Medicare Advantage plan, the hospital discharge team will usually handle the prior authorization process, but it’s worth confirming that this step has been completed before you transfer.
What Medicare Covers in the Facility
During a covered skilled nursing facility stay, Medicare Part A pays for a semi-private room, meals, skilled nursing care, physical and occupational therapy, speech-language pathology services, medical social services, medications administered in the facility, medical supplies, and equipment used during your stay. It’s a comprehensive package while you qualify.
What it does not cover: a private room (unless medically necessary), personal items like a telephone or television in your room, and any care that falls outside the skilled care requirement. If you want a private room for comfort, you’ll pay the difference out of pocket.
When Medicare Runs Out
If you still need nursing home care after Medicare coverage ends, or if you need long-term custodial care that Medicare never covered in the first place, payment options narrow quickly. Many people pay out of pocket initially, which can cost $8,000 to $10,000 or more per month depending on your location. Long-term care insurance, if you purchased it before needing care, can help cover these costs.
Medicaid is the primary public program that pays for long-term nursing home care, but it has strict income and asset limits. Eligibility rules vary by state. In some states, you must have been living in the nursing home for 30 consecutive days before you can even apply for Medicaid coverage. If you anticipate needing long-term care, contact your state’s Medicaid office early to understand the application timeline and what financial documentation you’ll need. The transition from Medicare-covered skilled care to Medicaid-funded long-term care is one of the most common paths into extended nursing home stays.
A Medigap (Medicare Supplement) policy can also help during the Medicare-covered portion. Many Medigap plans cover the daily coinsurance for days 21 through 100, which would otherwise cost you $209.50 per day in 2025.