Does Medicare cover nursing home care? Skilled nursing vs. long-term care

Who qualifies

1. 1

   A 3-day inpatient hospital stay

   At least 3 days in a row as a formally admitted inpatient. The admission day counts, the discharge day doesn't. Observation and ER time don't count.
2. 2

   Admission soon after

   You generally enter the facility within 30 days of leaving the hospital, for a condition treated there (or one that started during your facility care).
3. 3

   Daily skilled care

   A doctor orders daily skilled nursing, or therapy at least 5 days a week, that can only practically be given in a facility.
4. 4

   A Medicare-certified facility

   Some hospitals also offer this care in "swing beds," with the same rules and costs.

You may not need the 3-day stay if your doctor is part of an accountable care organization or other Medicare program with a "3-day rule waiver." Ask the doctor or hospital whether you and the facility qualify.

What you pay in 2026

Days 1 to 20

$0.

Days 21 to 100

$217 a day. Most Medigap plans cover this; Plans A and B don't, and K and L cover part.

After day 100

All costs. The 100 days renew in a new benefit period (after 60 days in a row out of the hospital and skilled care), but you'll generally need another 3-day inpatient stay first.

What's included

A semi-private room, meals, skilled nursing, therapy, medications, medical social services, supplies, and dietary counseling.

• The 100 days aren't guaranteed. Coverage ends when you no longer need daily skilled care, often after a few weeks.

Long-term care isn't covered

Medicare and Medigap don't pay for custodial care: help with bathing, dressing, eating or using the bathroom when that's the main care you need, whether in a nursing home or at home. People pay for it with Medicaid (if they qualify), long-term care insurance, or their own money. More on Medicare and Medicaid.

Medicare can't stop skilled care just because you aren't improving. Under a 2013 court settlement, skilled care to keep you from getting worse can be covered.

Medicare Advantage

Plans may waive the 3-day hospital stay, but they may charge copays starting on day 1, require approval first and use a network of facilities. Check your plan's Evidence of Coverage before choosing a facility.

When coverage ends

You get a notice

The facility must give you a Notice of Medicare Non-Coverage at least 2 days before covered care ends.

Fast appeal

Call the reviewer on the notice (your state's BFCC-QIO) as soon as you get it, by the deadline on the notice, usually noon the day before coverage ends. How appeals work.

Choosing a facility

Compare facilities on Medicare.gov's Care Compare, which rates them 1 to 5 stars on inspections, staffing and quality. Visit in person, and ask your state's long-term care ombudsman.

Common questions

Keep reading

• What Medicare covers for a hospital stay (and why "observation" matters)What Part A pays for a hospital stay, the 2026 deductible and daily costs, the difference between being an inpatient and "under observation," and the notices and appeal rights you have.
• Does Medicare cover home health care? Who qualifies and what's includedMedicare pays in full for part-time skilled care at home if you're homebound and need skilled nursing or therapy. What "homebound" means, what's covered and not, and what to do if an agency stops your care.
• Have Medicare and Medicaid? What changes, and how an agent can helpIf you qualify for both Medicare and Medicaid, you have extra help with costs, special plans, and more chances to change coverage. What to know, the 2025 rule changes, and what to watch for.