Does Medicare Cover Any Nursing Home Costs?

Medicare offers coverage for certain nursing home costs, though this coverage is limited and specific. It primarily applies to “skilled nursing facility” (SNF) care, which is rehabilitative rather than long-term care for daily living. This article details the conditions under which Medicare covers SNF care, including eligibility, duration of benefits, and patient costs.

Covered Skilled Nursing Facility Care

Skilled nursing facility care, as defined by Medicare, involves services provided by licensed nursing or therapy professionals. This care is distinct from general assistance with daily living. Examples of covered skilled services include intravenous injections, complex wound care, physical therapy, occupational therapy, and speech-language pathology services. These services help a patient recover from an illness, injury, or surgery.

In contrast, Medicare generally does not cover “custodial care,” which primarily assists with activities of daily living (ADLs). These activities include bathing, dressing, eating, using the restroom, and moving around. Medicare views these services as non-medical support, even when provided in nursing homes. The distinction between skilled nursing care and custodial care is central to Medicare’s coverage policies.

Meeting Coverage Requirements

To qualify for Medicare coverage of skilled nursing facility care, beneficiaries must meet several specific conditions. A primary requirement is a qualifying hospital stay: a prior medically necessary inpatient hospital admission of at least three consecutive days. Time spent in the emergency room or under observation status typically does not count toward this three-day requirement.

Following the qualifying hospital stay, the beneficiary must be admitted to a Medicare-certified skilled nursing facility generally within 30 days of leaving the hospital. The services provided in the SNF must be ordered by a doctor and must be for a medical condition treated during the hospital stay, or a new condition developed while in the SNF.

Furthermore, the patient must require daily skilled nursing care or skilled rehabilitation services that can only be provided by professional staff. If a patient only needs custodial care, Medicare will not cover the stay, even if other requirements are met. Some Medicare Advantage plans may offer different rules, but this varies by plan.

Coverage Duration and Patient Costs

Medicare’s coverage for skilled nursing facility care operates within a “benefit period.” A benefit period begins the day a beneficiary is admitted as an inpatient to a hospital or skilled nursing facility. It ends when the beneficiary has been out of a hospital or SNF for 60 consecutive days.

Within each benefit period, Medicare Part A covers up to 100 days of skilled nursing facility care. For the first 20 days, Medicare covers 100% of approved costs. For days 21 through 100, the beneficiary is responsible for a daily coinsurance amount.

In 2025, this daily coinsurance amount is $209.50. After day 100 in a benefit period, Medicare typically covers no further costs for skilled nursing facility care. Beneficiaries are responsible for all costs beyond this limit, unless they have other insurance or qualify for a new benefit period after a 60-day break in care.

Expenses Not Covered by Medicare

While Medicare provides some coverage for skilled nursing facility care, it does not cover all nursing home expenses. Long-term care that is primarily custodial, focusing on assistance with daily activities rather than medical treatment, is generally not covered. This includes help with bathing, dressing, or eating.

Medicare also does not cover room and board costs in a nursing home, even during a covered skilled nursing stay. This includes charges for a private room, meals, and general living expenses. Personal care items, laundry services, and entertainment activities are typically not covered.

Medicare’s SNF benefit is designed for short-term, rehabilitative care following an acute medical event, not for indefinite stays. Long-term nursing home stays are largely the financial responsibility of the individual. Beneficiaries should understand these limitations.