When Does Medicare Cover Nursing Home Care?

Medicare is a federal health insurance program. It primarily serves people aged 65 or older, some younger people with disabilities, and individuals with End-Stage Renal Disease. This program helps manage the financial burden associated with various medical services, including certain types of care provided in nursing homes. Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.

Types of Care Covered by Medicare

Medicare covers Skilled Nursing Facility (SNF) care. An SNF provides temporary residence for patients needing medically necessary rehabilitation and treatment after a hospitalization. This care is distinct from general nursing home stays, as it focuses on recovery from illness, injury, or surgery to improve health and functional abilities. Services covered under SNF care include skilled nursing, physical therapy, occupational therapy, and speech-language pathology services.

Skilled nursing care involves medical services provided by licensed healthcare professionals or under their supervision. Examples include wound care, intravenous fluids or medications, and rehabilitation therapies. Medicare’s coverage for these services requires medical necessity to treat or manage a condition. The care provided in an SNF is intended to be short-term and rehabilitative, helping patients transition back home or to a less intensive care setting.

Eligibility Requirements for Medicare Coverage

Medicare coverage for a Skilled Nursing Facility stay depends on meeting conditions. An individual must have a qualifying inpatient hospital stay before admission to the SNF. This requires a medically necessary inpatient hospital stay of at least three consecutive days, starting from admission as an inpatient. Time spent under observation status or in the emergency room does not count toward this three-day requirement.

Following the qualifying hospital stay, the transfer to the SNF must occur within 30 days of the hospital discharge. The SNF care must be for a condition treated during the qualifying hospital stay or a new condition that developed while receiving Medicare-covered SNF care. A physician must certify the daily need for skilled nursing or therapy services. These services must be reasonable and necessary for diagnosis or treatment and provided by a Medicare-certified SNF.

Duration and Cost Sharing for Covered Stays

Medicare Part A covers Skilled Nursing Facility care for a limited duration. During the first 20 days of a covered SNF stay within a benefit period, Medicare pays 100% of the costs. This period supports immediate post-hospitalization recovery. The financial responsibility shifts after this initial period, requiring a daily beneficiary contribution.

For days 21 through 100 of a covered SNF stay, the beneficiary pays a daily coinsurance amount. In 2025, this daily coinsurance is $209.50. After 100 days within a benefit period, Medicare coverage for SNF care ceases, and the beneficiary becomes responsible for all costs. This structure emphasizes Medicare’s role in supporting short-term, rehabilitative care rather than long-term custodial needs.

A “benefit period” tracks an individual’s use of hospital and SNF services under Original Medicare. It begins when a person is admitted as an inpatient to a hospital or SNF. A benefit period ends when 60 consecutive days pass without inpatient hospital care or skilled SNF care. If a new inpatient stay occurs after 60 consecutive days without skilled care, a new benefit period begins, resetting coverage days and cost-sharing.

Care Not Covered by Medicare

Medicare does not cover all types of care provided in a nursing home setting. Primarily, it does not cover “custodial care” when it is the only care needed. Custodial care involves non-medical assistance with daily living activities, such as bathing, dressing, eating, and personal care. These services help individuals with their activities of daily living but do not require professional medical skills or training.

Medicare’s focus remains on skilled, medically necessary care, not on long-term personal care. Consequently, Medicare does not cover long-term stays in nursing homes, assisted living facilities, or adult daycare. While a nursing home might provide both skilled and custodial care, Medicare’s coverage is limited to the skilled services, emphasizing a short-term, rehabilitative purpose. If a person only requires assistance with daily activities and no longer needs skilled nursing or therapy, Medicare coverage will end.