How Much Will Medicare Pay for Nursing Home Care?

Medicare is a federal health insurance program, but its coverage for nursing home care is specific and limited. This article clarifies how Medicare applies to different types of nursing home care and outlines the conditions and payment structures involved.

Understanding Medicare’s Scope for Nursing Home Care

Nursing home facilities provide various levels of care. Medicare, primarily Medicare Part A (Hospital Insurance), focuses its coverage on Skilled Nursing Facility (SNF) care.

Skilled nursing facility care involves services that can only be provided safely and effectively by, or under the supervision of, trained medical professionals. This includes daily skilled nursing services, such as intravenous fluids or wound care, and rehabilitation services like physical therapy, occupational therapy, or speech-language pathology services. Medicare Part A is designed to cover this type of rehabilitative or recovery-focused care in a Medicare-certified SNF.

Conversely, custodial care, which involves assistance with activities of daily living (ADLs) such as bathing, dressing, eating, or using the bathroom, is not covered by Medicare. This type of care is considered non-medical and supportive. Therefore, for Medicare to provide any coverage in a nursing home setting, the care must meet the definition of skilled nursing care and not solely be for assistance with daily living activities.

Conditions for Skilled Nursing Facility Coverage

For Medicare to cover a stay in a Skilled Nursing Facility, several specific requirements must be met. A primary condition is the “qualifying hospital stay,” meaning the individual must have had a medically necessary inpatient hospital stay of at least three consecutive days. This three-day count begins on the day of inpatient admission and does not include the day of discharge. Time spent in the hospital under observation status does not count towards this three-day inpatient requirement.

Following the qualifying hospital stay, the individual must be admitted to a Medicare-certified SNF within a short timeframe, generally 30 days of leaving the hospital. A doctor or other healthcare provider must certify that daily skilled nursing care or rehabilitation services are needed for a medical condition that was treated during the qualifying hospital stay, or for a condition that arose while receiving care in the SNF for the original condition. The care must be of a type that only skilled nursing or therapy staff can provide or supervise safely and effectively.

How Medicare Pays for Skilled Nursing Facility Care

Once an individual meets the eligibility conditions, Medicare Part A covers Skilled Nursing Facility care for a limited period within a “benefit period.” A benefit period begins the day an individual is admitted as an inpatient to a hospital or a SNF. This period ends when the individual has not received inpatient hospital care or Medicare-covered skilled care in a 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 the approved costs, meaning there is no coinsurance amount for the beneficiary. For days 21 through 100 of the benefit period, the beneficiary is responsible for a daily coinsurance amount. In 2025, this daily coinsurance is $209.50.

After day 100 within a benefit period, Medicare generally ceases to pay for SNF care. At this point, the individual becomes responsible for all costs associated with their nursing home stay. These payments apply only to Medicare-approved services and facilities, ensuring that the care meets federal standards and is deemed medically necessary.

After Medicare Coverage Ends

When Medicare’s limited coverage for Skilled Nursing Facility care concludes, the financial responsibility for nursing home services shifts. This can occur either after the 100 days of Medicare SNF coverage within a benefit period are exhausted, or if the individual no longer requires daily skilled care, even if they have not used all 100 days. Medicare’s coverage is contingent upon the ongoing medical necessity for skilled services.

If the care needed is purely custodial in nature, focusing solely on assistance with daily activities and not requiring skilled medical oversight, Medicare will not cover these costs at any point. In such scenarios, or once the Medicare SNF benefit is depleted, the individual or their family becomes fully responsible for the cost of the nursing home care.