Does Medicare Pay for Nursing Home Care? The 100-Day Rule Explained

Medicare pays for nursing home care only in a limited way: it covers up to 100 days of short-term care in a Medicare-certified skilled nursing facility (SNF) per benefit period, and only after a qualifying inpatient hospital stay of at least three days. In 2026, days 1 through 20 cost you $0, days 21 through 100 cost $217 per day, and from day 101 you pay everything. Medicare does not pay for long-term custodial care, which is the help with bathing, dressing, eating and supervision that most long-term nursing home residents need.

That gap catches many families off guard. Below we walk through exactly what Medicare covers, the rules that trip people up (especially “observation status”), how Medicare Advantage and Medigap change the math, and who actually pays when a parent needs to stay in a nursing home for months or years.

Medicare and nursing homes at a glance

Question	Short answer (2026)
Does Medicare cover nursing home care?	Only short-term skilled nursing or rehab care in a Medicare-certified SNF
Maximum days covered	100 days per benefit period
Hospital stay required first?	Yes, at least 3 consecutive days as an admitted inpatient (Original Medicare)
Cost for days 1 to 20	$0 per day
Cost for days 21 to 100	$217 per day
Cost from day 101	You pay all costs
Long-term custodial care	Not covered by Medicare
Main payer for long-term stays	Medicaid, followed by private savings and long-term care insurance

Source: Medicare.gov, Skilled nursing facility care; CMS 2026 Medicare Parts A and B Premiums and Deductibles fact sheet.

Skilled nursing care vs. custodial care: the distinction that decides everything

Medicare is health insurance, so it pays for medical care that needs licensed professionals. Nursing homes provide two very different kinds of care, often under the same roof:

• Skilled nursing care is care that must be given or supervised by registered nurses or licensed therapists. Examples include IV medications, wound care after surgery, managing a new feeding tube, and daily physical, occupational or speech therapy after a stroke or hip replacement. This is what Medicare can cover.
• Custodial care is help with activities of daily living such as bathing, dressing, eating, using the toilet and moving from bed to chair, plus supervision for someone with dementia. When this is the only care a person needs, Medicare does not pay for it, whether it happens in a nursing home, an assisted living community or at home.

In practice, a Medicare-covered SNF stay is usually a rehab stay after a hospitalization. Someone who lives in a nursing home long-term because they can no longer manage at home is almost always receiving custodial care, and that is paid for some other way. If you are weighing the options for someone with dementia, our guide to memory care vs. a nursing home explains how the settings differ.

How long does Medicare pay for nursing home care?

Medicare pays for up to 100 days of SNF care in each benefit period, but “up to” is doing a lot of work in that sentence. Coverage lasts only as long as you keep meeting the requirements, mainly the need for daily skilled care. Many stays end well before day 100 because the person improves, reaches a plateau the care team considers stable, or moves home.

2026 costs by day

Days in the SNF (per benefit period)	What you pay in 2026	What Medicare pays
Days 1 to 20	$0 per day	All covered costs
Days 21 to 100	$217 per day (up to $17,360 for all 80 days)	Everything above your daily coinsurance
Day 101 and beyond	All costs	Nothing

Source: CMS 2026 Medicare Parts A and B Premiums and Deductibles fact sheet; Medicare.gov.

Because you need a hospital stay to qualify, you will normally already have paid the 2026 Part A inpatient deductible of $1,736 for that benefit period. You do not pay it again for the SNF stay in the same benefit period.

What a benefit period is

A benefit period starts the day you are admitted as a hospital inpatient (or to a SNF) and ends once you have gone 60 days in a row without inpatient hospital care or skilled care in a SNF. The 100-day clock resets only when a new benefit period starts. There is no limit on how many benefit periods you can have, but each new one comes with a new Part A deductible and requires a new qualifying hospital stay before SNF coverage applies again.

Example: your mother uses 45 SNF days after a hip fracture, goes home, and is readmitted to the hospital three weeks later. She is still in the same benefit period, so she has 55 SNF days left. If she had stayed out of the hospital and SNF for 60 straight days first, she would start a fresh benefit period with 100 days available.

Coverage does not depend on getting better

Families are sometimes told Medicare will stop because a patient “isn’t improving.” Under the 2013 Jimmo v. Sebelius settlement, CMS confirmed that coverage for SNF, home health and outpatient therapy depends on whether a person needs skilled care, including skilled care to maintain their condition or slow decline, not on whether they can improve. If a facility uses “no progress” as the only reason to end coverage, ask for that in writing and consider an appeal.

Who qualifies: Medicare’s SNF requirements

Under Original Medicare, all of these must be true:

Requirement	What it means in plain terms
Part A coverage with days left	You have Medicare Part A and have not used all 100 SNF days in this benefit period
Qualifying hospital stay	At least 3 consecutive days as an admitted inpatient, not counting the day of discharge
Timely admission	You enter the SNF within a short time of leaving the hospital, generally 30 days
Daily skilled need	A doctor or other provider certifies you need skilled nursing or therapy services every day (therapy can count if given at least 5 days a week)
Related condition	The SNF care treats a condition treated in the hospital, or one that started during the SNF stay for that condition
Medicare-certified facility	The nursing home is certified by Medicare as a SNF

Source: Medicare.gov, Skilled nursing facility care. Rules differ for Medicare Advantage plans.

The 3-day rule and the observation status trap

The three-day hospital rule is where most denials start. The three days must be days as a formally admitted inpatient. The count starts on the day the doctor writes the inpatient admission order and does not include the day you leave. Time in the emergency room, or time spent as an outpatient “under observation,” does not count, even if you were in a hospital bed overnight for several nights.

This is why a patient can spend four nights in the hospital, go to a nursing home for rehab, and then receive a bill for the entire stay. On paper, they may have had only one or two inpatient days, or none.

The MOON notice

Hospitals must give a Medicare patient who receives observation services for more than 24 hours a Medicare Outpatient Observation Notice (MOON), no later than 36 hours after observation starts. It explains that you are an outpatient and how that affects what you pay, including SNF eligibility. The rule applies to Original Medicare and Medicare Advantage patients. If you or a parent is handed a MOON, take it seriously: it means the clock for the 3-day rule may not be running.

What to do if you are in observation status

1. Ask every day: “Is my parent an inpatient or an outpatient under observation?” Write down the answer and the name of the person who told you.
2. Ask the doctor directly whether the medical situation justifies an inpatient admission order. Only the physician can admit, and the decision is based on medical need.
3. Know your appeal rights. Since February 14, 2025, Original Medicare patients who are admitted as inpatients and then switched to outpatient observation can file an expedited appeal while still in the hospital if their hospital stay lasted at least three days or they do not have Part B. The hospital should give a Medicare Change of Status Notice, and a Quality Improvement Organization (QIO) decides within about a day.
4. Retrospective appeals for older stays (back to January 1, 2009) had a filing window that closed on January 2, 2026. CMS says late requests are denied unless you can show good cause, so if this applies to your family, contact your State Health Insurance Assistance Program (SHIP) quickly.
5. Plan for options if you do not qualify: home health care, outpatient therapy, or paying privately for a short rehab stay.

What Medicare covers during a SNF stay

When you qualify, Medicare Part A covers:

• A semi-private room (a private room only if medically necessary)
• Meals and dietary counseling
• Skilled nursing care
• Physical, occupational and speech-language therapy needed to meet your health goal
• Medications given in the facility
• Medical supplies and equipment used in the facility
• Medical social services
• Ambulance transport to the nearest provider of needed services when other transport would endanger your health

It does not cover personal items, a private room you choose for comfort, private-duty nursing, or a phone or TV charge if the facility bills separately.

Medicare Advantage: different rules, more paperwork

Medicare Advantage (Part C) plans must cover SNF care, but they set their own rules within Medicare’s limits. The differences that matter most:

Feature	Original Medicare	Medicare Advantage
3-day hospital stay	Required	Many plans waive it; check your plan’s Evidence of Coverage
Prior authorization	Not required	Usually required; KFF found 95% of enrollees are in plans requiring it for SNF stays in 2026
Days 1 to 20	$0	Plans may charge daily copays starting on day 1
Days 21 to 100	$217 per day	Plan copay, which may be lower or higher
Facility choice	Any Medicare-certified SNF with a bed	Usually in-network facilities only
Out-of-pocket cap	None (unless you have Medigap)	Yearly in-network maximum applies

Source: Medicare.gov; KFF analysis of Medicare Advantage prior authorization for post-acute care, July 2026.

Prior authorization denials are common for post-acute care. KFF reported that 12% of SNF prior authorization requests were initially denied in June 2024 data, compared with under 8% for all services. Only 18% of those SNF denials were appealed, but about 95% of the appealed denials were ultimately approved. The lesson: if a Medicare Advantage plan denies a SNF stay, appeal. Ask the hospital case manager to help, since they file these requests every day.

A side note for Original Medicare: some Accountable Care Organizations in the Medicare Shared Savings Program have a CMS waiver of the 3-day rule for patients assigned to them. Ask the hospital case manager whether it applies.

Does Medigap cover nursing home coinsurance?

A Medicare Supplement (Medigap) policy can cover the $217 daily coinsurance for days 21 through 100, which is the biggest out-of-pocket risk in a long rehab stay. It does not extend coverage past day 100 or pay for custodial care.

Medigap plan	SNF coinsurance (days 21 to 100)
Plans C, D, F, G, M, N	100% covered
Plan L	75% covered
Plan K	50% covered
Plans A and B	Not covered

Source: Medicare.gov, Compare Medigap plan benefits. Plans C and F are sold only to people who became eligible for Medicare before January 1, 2020. Massachusetts, Minnesota and Wisconsin standardize Medigap differently.

Plans K and L have yearly out-of-pocket limits ($8,000 and $4,000 in 2026); once you reach the limit, they pay 100% of covered services for the rest of the year.

Who pays for long-term nursing home care?

Once Medicare stops, or if Medicare never applied because the need is custodial, the bill is significant. The CareScout 2025 Cost of Care Survey puts the national median at $315 a day for a semi-private room and $355 a day for a private room.

Nursing home room type	Daily (national median)	Monthly (approx.)	Yearly
Semi-private room	$315	$9,581	$114,975
Private room	$355	$10,798	$129,575

Source: CareScout Cost of Care Survey 2025 (released March 2026). Monthly figures are daily rates times 365, divided by 12. Costs vary widely by state.

For a state-by-state look, see our guide to how much a nursing home costs. Here is how families typically pay:

Medicaid

Medicaid is the largest payer for long-term nursing home care. KFF reports that over 60% of the roughly 1.2 million nursing facility residents in July 2024 had Medicaid as their primary payer. Medicaid covers custodial care with no day limit for people who meet their state’s medical and financial rules, which generally include low countable assets and income that goes toward the cost of care (minus a small personal allowance).

Married couples have protections. In 2026, a spouse who stays at home can keep between $32,532 and $162,660 in countable resources depending on the state, and may receive part of the nursing home spouse’s income up to a maximum monthly maintenance allowance of $4,066.50. Medicaid also looks back five years for gifts or transfers made for less than fair value. Rules and figures vary by state, so confirm with your state Medicaid agency. Our full guide on whether Medicaid pays for nursing home care covers eligibility and the application process.

Private pay

Many residents start by paying from savings, pensions, Social Security and the sale of a home, then apply for Medicaid once their assets are spent down to their state’s limit. If you expect to need Medicaid later, ask before admission whether the facility accepts Medicaid and whether it has Medicaid beds.

Long-term care insurance

Traditional and hybrid long-term care policies pay for custodial care once the policyholder needs help with a set number of daily activities (commonly two of six) or has a cognitive impairment. Read the policy for the daily benefit amount, the elimination period (often 30 to 90 days of paying yourself first) and the lifetime maximum.

Veterans benefits

The VA must provide nursing home care to veterans who need it because of a service-connected disability, have a combined rating of 70% or more, or meet certain other rating criteria. Others may get care in VA Community Living Centers, contracted community nursing homes or State Veterans Homes as resources allow, sometimes with a copay. Wartime veterans and surviving spouses with limited income may also qualify for a VA pension with Aid and Attendance; from December 1, 2025, the maximum annual pension rate with Aid and Attendance is $29,093 for a veteran with no dependents and $34,488 with one dependent. Learn more in our guide to VA Aid and Attendance.

Hospice, when it applies

If a nursing home resident is terminally ill, Medicare’s hospice benefit can cover hospice services in the facility, though not the room and board. See who pays for hospice care for how that works.

When Medicare coverage ends: notices and appeals

A SNF must give you a written Notice of Medicare Non-Coverage at least two days before your Medicare-covered services end. If you think it is too soon, you can request a fast appeal:

1. Read the notice for the date coverage ends and the phone number of your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
2. Call the BFCC-QIO by noon the day before the termination date on the notice. You can call yourself or have a family member or representative call.
3. Get the facility’s explanation. The SNF must give you a Detailed Explanation of Non-Coverage by the end of the day the QIO contacts it.
4. Ask the doctor for support. A note from the physician or therapist explaining why daily skilled care is still needed helps.
5. Wait for the decision. The QIO usually decides by close of business the day after it receives the information it needs. While the appeal is pending, you are not responsible for services before the coverage end date.

If you miss the deadline, you can still appeal through the standard process, but you may owe for the days in between. Medicare Advantage members appeal through their plan first, and those rules differ. Your local SHIP offers free one-on-one help with Medicare appeals.

Planning ahead: what families can do now

• During any hospital stay, confirm inpatient vs. observation status daily.
• Before discharge, ask the case manager for a list of Medicare-certified SNFs, and check star ratings on Medicare’s Care Compare tool.
• Around day 14 of rehab, ask the care team for a realistic discharge plan so you are not surprised by a non-coverage notice.
• If returning home isn’t safe, start comparing longer-term options early. Some people move from rehab to assisted living rather than a nursing home; our guide on when to move from assisted living to a nursing home explains where the line usually falls.
• If dementia is involved, understand early that Medicare will not pay for long-term memory care either. See does Medicare pay for assisted living for dementia.
• If going home is the plan, Medicare may cover skilled care there. Read does Medicare cover home health care.

FAQs

Does Medicare pay for nursing home care?

Medicare pays for short-term skilled nursing facility care, typically rehab after a hospital stay, for up to 100 days per benefit period. It does not pay for long-term custodial care in a nursing home, which is what most long-term residents need.

How long does Medicare pay for nursing home care?

Up to 100 days per benefit period, as long as you keep needing daily skilled care. Days 1 to 20 are fully covered, and days 21 to 100 carry a $217 daily coinsurance in 2026. Many stays end earlier because the skilled need ends.

Does Medicare cover nursing home costs after 100 days?

No. From day 101 of a benefit period you pay all costs, unless you have another payer such as Medicaid, long-term care insurance or VA benefits. Medigap does not extend coverage past day 100.

What is the 3-day rule for Medicare nursing home coverage?

Under Original Medicare, you need at least three consecutive days as an admitted hospital inpatient before Medicare covers a SNF stay. The day of discharge, emergency room time and observation time do not count.

Do observation days count toward the 3-day stay?

No. Observation is outpatient care, even if you stay overnight in a hospital bed. If you receive observation for more than 24 hours, the hospital must give you a MOON notice explaining your status.

How much does a nursing home cost per day with Medicare in 2026?

Nothing for days 1 to 20 of a qualifying stay, $217 per day for days 21 to 100, and the full facility rate after that. The national median full rate is $315 per day for a semi-private room (CareScout 2025).

Does Medicare Advantage cover nursing homes?

Medicare Advantage plans cover skilled nursing facility care with at least the same 100-day limit, and many waive the 3-day hospital rule. Most require prior authorization, may charge copays from day 1, and limit you to network facilities. They do not cover long-term custodial care.

Will Medicare pay for a nursing home for someone with dementia?

Only if the person has a qualifying hospital stay and needs daily skilled care, such as therapy or wound care, and only for up to 100 days. Dementia care that is supervision and help with daily activities is custodial, so Medicare does not cover it.

Does Medicare pay if my parent is not improving?

Yes, it can. Since the Jimmo v. Sebelius settlement, coverage depends on the need for skilled care, including care to maintain a condition or slow decline, not on whether the person is improving.

Who pays for nursing home care when Medicare stops?

Usually Medicaid (the primary payer for over 60% of residents), private savings, long-term care insurance, or VA benefits for eligible veterans. Medicaid eligibility rules vary by state, so check with your state Medicaid agency.

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Related guides

• Does Medicaid pay for nursing home care?
• How much does a nursing home cost?
• When to move from assisted living to a nursing home