How Many Days Does Medicare Pay for a Nursing Home?

Medicare Part A provides benefits for skilled nursing facility (SNF) care for older adults and individuals with certain disabilities. Medicare’s coverage for SNF care is primarily for short-term, rehabilitative needs following a hospital stay. This coverage is distinct from long-term custodial care, which typically involves assistance with daily activities and is generally not covered by Medicare.

Medicare’s Coverage Criteria for Skilled Nursing Facilities

Medicare covers skilled nursing facility stays under specific conditions. A primary requirement is a “qualifying inpatient hospital stay” of at least three consecutive days. This means an individual must have been formally admitted to a hospital as an inpatient for three days, starting from the admission day but not including the day of discharge. Time spent under observation status in a hospital, even overnight, does not count towards this three-day inpatient requirement.

Following this qualifying hospital stay, admission to a Medicare-certified SNF must generally occur within 30 days of leaving the hospital. The SNF care must address a condition treated during the hospital stay, or a new condition that arose while receiving SNF care for the original condition.

The care received in the SNF must be “skilled care,” which involves services that can only be safely and effectively provided by, or under the supervision of, licensed healthcare professionals. Examples include intravenous injections, complex wound care, and physical, occupational, or speech therapy. A physician must certify that the individual requires daily skilled nursing or rehabilitation services. This type of care differs from “custodial care,” which focuses on assistance with activities of daily living like bathing, dressing, or eating, and can be provided by non-medical personnel.

The care must be aimed at improving the individual’s condition, maintaining their current condition to prevent deterioration, or slowing the progression of a disease. The facility itself must be Medicare-certified, meaning it meets specific federal health and safety standards. If any of these criteria are not satisfied, Medicare Part A will not cover the skilled nursing facility stay.

Medicare’s Benefit Period and Coverage Limits

Medicare’s “benefit period” defines the limits of SNF coverage. A benefit period begins the day an individual is admitted as an inpatient to a hospital or skilled nursing facility. This period is not tied to a calendar year, meaning multiple benefit periods can occur within the same year.

A benefit period ends when an individual has not received any inpatient hospital care or skilled care in a SNF for 60 consecutive days. If, after this 60-day break, an individual is readmitted to a hospital for another qualifying inpatient stay and then requires skilled nursing care, a new benefit period begins. There is no lifetime limit on the number of benefit periods an individual can have.

Within each benefit period, Medicare Part A provides coverage for up to 100 days of skilled nursing facility care. For the first 20 days of a Medicare-covered SNF stay within a benefit period, Medicare pays 100% of the approved costs, meaning the beneficiary pays nothing. However, for days 21 through 100 of the SNF stay within the same benefit period, Medicare pays for a portion of the costs, but the beneficiary is responsible for a daily copayment. For 2025, this daily copayment is $209.50. After day 100 in a benefit period, Medicare Part A coverage for the SNF stay ceases, and the beneficiary becomes responsible for all costs.

Understanding Copayments and Post-Coverage Options

For a Medicare-covered skilled nursing facility stay, the beneficiary is responsible for a daily copayment of $209.50 for days 21 through 100 in 2025. This amount is typically paid directly by the beneficiary, though supplemental insurance plans, such as Medigap policies, may help cover this cost. It is important to verify coverage details with any supplemental plans.

Once an individual reaches day 101 of a skilled nursing facility stay within a benefit period, Medicare Part A coverage for that stay ends. At this point, the individual becomes fully responsible for the cost of continued care. Since Medicare does not cover long-term or custodial care, other financial avenues must be explored for ongoing needs.

One common option is private pay, where individuals use their personal savings, pensions, or other assets to cover the daily costs of nursing home care. Long-term care insurance policies, if purchased beforehand, can also provide financial assistance for extended nursing home stays, as they are specifically designed to cover such expenses. These policies have varying benefits and waiting periods, depending on the specific plan.

Medicaid serves as another significant payer for long-term nursing home care, but it is a needs-based program. Eligibility for Medicaid depends on strict income and asset limits, which vary. For veterans, certain benefits through the Department of Veterans Affairs may also be available to help cover nursing home costs, depending on service history and specific needs.