How Much Does Medicare Pay for Nursing Home Care?

Medicare serves as the primary health insurance program for many older adults and certain younger individuals with disabilities. While it covers medical expenses, its coverage for long-term nursing home care is specific and limited. Medicare primarily focuses on medical and rehabilitative needs, not extended personal care or prolonged stays for non-medical reasons.

Medicare Coverage for Skilled Nursing Facility Care

Medicare Part A covers care in a Skilled Nursing Facility (SNF) under specific conditions. An SNF is an inpatient center with medical professionals and rehabilitation services, designed for temporary stays after a hospital discharge. To qualify for Medicare SNF coverage, several criteria must be met, starting with a qualifying hospital stay.

A qualifying hospital stay requires inpatient admission to a hospital for at least three consecutive days, excluding observation status or discharge day. Admission to a Medicare-certified SNF must occur within 30 days of leaving the hospital. A doctor must also certify the individual needs daily skilled nursing or therapy services, such as physical, occupational, or speech therapy. This care must be medically necessary and related to the condition treated during the hospital stay.

Duration and Cost Sharing

Once conditions for Medicare-covered SNF care are met, Medicare Part A covers a defined period. This coverage operates within a “benefit period,” which begins the day an individual is admitted as an inpatient to a hospital or SNF. A benefit period concludes when the individual has been out of a hospital or SNF for 60 consecutive days. There is no limit to the number of benefit periods an individual can have.

For the first 20 days of a Medicare-covered SNF stay, Medicare pays 100% of approved costs, so the beneficiary pays nothing. For days 21 through 100 within the same benefit period, a daily co-insurance amount applies. In 2025, this co-insurance is $209.50 per day. After day 100 in a benefit period, Medicare coverage for the SNF stay ceases, and the individual becomes responsible for all costs.

Services Not Covered by Medicare

Medicare’s nursing home coverage is limited to skilled medical or rehabilitative services. It does not cover “custodial care,” which is the majority of care needed in long-term nursing homes. Custodial care involves assistance with routine daily activities that do not require specialized medical skills. These activities include bathing, dressing, eating, using the bathroom, and moving around.

Medicare does not cover custodial care if it is the only care an individual needs. This means Medicare will not pay if a nursing home is required solely for help with daily living tasks due to chronic illness or disability. Other services not covered include personal convenience items and private duty nursing. Medicare is not designed as a long-term care solution for indefinite stays.

Paying for Nursing Home Care Beyond Medicare

When Medicare coverage for skilled nursing facility care ends, or for care it does not cover, individuals must explore alternative payment methods. One common option is private pay, where individuals use their personal savings, investments, or other assets to cover nursing home care costs. This method serves as the initial payment source until other options become available.

Medicaid, a joint federal and state program, provides health coverage to low-income individuals and families, covering long-term nursing home care, including custodial care. Eligibility for Medicaid is based on state-specific income and asset limits. Veterans’ benefits can also offer financial assistance for eligible veterans and their spouses, such as through the Aid and Attendance pension. Long-term care insurance is another option, involving private policies purchased to cover services like nursing home care when an individual cannot perform a certain number of daily living activities. These alternatives are important for managing the significant costs of extended nursing home stays.