Does Medicare cover nursing home care?
Medicare pays for a nursing home when the stay is rehabilitation after a hospital admission, and stops when the need becomes help with daily living. Most of the surprises families run into come from that line and from the three-day rule in front of it.
Only for short-term skilled care. Medicare Part A covers care in a Medicare-certified skilled nursing facility after a qualifying inpatient hospital stay of at least three days in a row (not counting the day you leave), when a doctor certifies you need daily skilled nursing or therapy. It pays up to 100 days per benefit period: days 1–20 at $0 a day, days 21–100 at $217 a day in 2026, and nothing from day 101. Time in the hospital under observation doesn't count toward the three days, even overnight. Medicare doesn't cover long-term custodial care, meaning help with bathing, dressing, eating and other daily activities, when that's the only care you need. In New York that is paid by Medicaid for people who qualify, by long-term care insurance, or privately.
Skilled care versus custodial care
A nursing home can be two different things, and Medicare treats them differently.
- Skilled nursing facility care is short-term medical care that has to be given by, or supervised by, licensed nurses or therapists: rehabilitation after a hip replacement, IV medication, wound care, therapy after a stroke. Medicare Part A covers it for a limited time. The care doesn't have to make you better; it can be covered when it's needed to maintain your condition or slow a decline.
- Custodial care is help with daily living: bathing, dressing, eating, using the bathroom, getting in and out of bed. When that is the only care you need, Medicare doesn't pay for it, whether it's in a nursing home, in assisted living or at home. This is what most people mean by long-term care.
The same building often provides both. The question that decides who pays is not where you are, but which kind of care you're getting that day.
The conditions for a covered stay
- A qualifying hospital stay: a medically necessary inpatient stay of at least three days in a row, counting the day you're admitted and not the day you leave.
- A short gap: you enter the skilled nursing facility within a short time of leaving the hospital, generally 30 days.
- A daily skilled need, certified by your doctor, for a condition treated during the hospital stay or one that started while you were getting skilled care for it.
- A Medicare-certified facility, and days left in your benefit period.
Covered services include a semi-private room, meals, skilled nursing, therapy, medications, medical supplies and medical social services.
The observation-status trap
Hospitals often keep patients "under observation" while they decide whether to admit them. Observation is outpatient care, even if you spend several nights in a hospital bed, and those days don't count toward the three. A family can believe their parent had a four-day hospital stay and then learn the nursing home stay isn't covered because only one of those days was inpatient. More in observation status vs inpatient admission.
- Ask every day whether you are an inpatient or an outpatient, and ask the doctor or a hospital social worker if the answer is observation.
- Read the notice. If you're under observation for more than 24 hours, the hospital must give you the Medicare Outpatient Observation Notice explaining your status and what it means for your costs.
- Status changes can be appealed. If you were admitted as an inpatient and the hospital changed you to outpatient observation, Medicare says you may be able to appeal. Raise it before discharge.
Some Medicare Advantage plans don't require the three-day stay at all, and doctors in some Accountable Care Organizations can waive it too. Ask before a planned surgery.
What it costs in 2026
| Days in the benefit period | What you pay (Original Medicare, 2026) |
|---|---|
| Days 1–20 | $0 a day. The $1,736 Part A deductible applies, but you don't pay it again if you already paid it for the hospital stay in the same benefit period. |
| Days 21–100 | $217 a day |
| Day 101 and after | All costs |
A benefit period starts the day you're admitted as an inpatient to a hospital or skilled nursing facility and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a facility. A new benefit period brings a new Part A deductible and a new set of up to 100 skilled nursing days. There's no limit to the number of benefit periods.
- Medigap: most plans pay the $217 daily coinsurance in full; Plans A and B don't, Plan K pays half and Plan L pays 75%. See the Medigap plans in New York table.
- Medicare Advantage: plans cover the same skilled nursing benefit with their own rules. They may charge copays during the first 20 days, usually require an in-network facility and often prior authorization, and may waive the three-day stay. The plan's Evidence of Coverage has the numbers.
- Day 100 is a ceiling, not a promise. Coverage ends sooner if you no longer need daily skilled care. If you disagree with a discharge, you can appeal.
When the need becomes long-term
When the skilled need ends, or day 100 passes, and the person still can't live safely without help, the stay becomes custodial and Medicare stops paying for the room, the meals and the aides. Medicare still pays for doctor visits and Part B therapy while you live there. In New York the cost from that point is paid one of three ways:
- Medicaid, for people who qualify on income and assets. Nursing home Medicaid is decided by the county Department of Social Services. It looks back at gifts and transfers of assets made before the application, and a transfer for less than fair value can lead to a penalty period with no coverage. The rules are detailed; an elder-law attorney or the county office is the place for specifics. For how Medicare and Medicaid work together, see Medicare and Medicaid together, and for programs that help with Medicare's own costs, help paying for Medicare.
- Long-term care insurance, for people who bought a policy years earlier.
- Private funds.
Assisted living follows the same rule: Medicare doesn't pay the facility, and covers your medical care while you live there.
Hospice in a nursing home
Someone who lives in a nursing home can get Medicare hospice care there if they qualify. Hospice covers the medical care, nursing, drugs for pain and symptom control and support for the family. It doesn't cover room and board, so the nursing home's daily charge stays with the resident, Medicaid or other coverage.
How I help
I can't place anyone in a facility, and I don't do Medicaid planning. What I can do is tell you exactly what your Medicare coverage pays for a rehab stay before a planned surgery, compare how Advantage plans handle skilled nursing and the three-day rule, and check whether a Medigap plan would cover the daily coinsurance. Related: does Medicare cover home health care? · Ask.
By county: Albany · Saratoga · Schenectady · Rensselaer · Warren · Washington · Montgomery · Fulton · Columbia · Greene · Schoharie · Otsego · Herkimer · Hamilton · Essex · Ulster · Dutchess. Town pages: every town, grouped by county. Anywhere else in New York.
- Skilled nursing facility (SNF) care (Medicare.gov) — conditions; 2026 costs: $0 days 1–20 after the $1,736 deductible, $217 days 21–100; observation time doesn't count; Advantage plans may waive the 3-day stay; checked October 14, 2026
- Your Medicare Benefits, publication 10116 (Medicare.gov, PDF) — benefit period definition; SNF conditions; improve-or-maintain; long-term care; hospice room and board
- Nursing home care (Medicare.gov) — custodial care not covered if it's the only care you need
- Long-term care (Medicare.gov) — Medicare and Medigap don't pay; Medicaid or long-term care insurance
- Inpatient or outpatient hospital status (Medicare.gov) — observation is outpatient even overnight; MOON after 24 hours
- Hospice care (Medicare.gov) — room and board not covered in a nursing home
- Compare Medigap plan benefits (Medicare.gov) — SNF coinsurance: K 50%, L 75%
- Medicaid regional rates for transfer penalty periods, 2026, GIS 25 MA/14 (NY DOH, PDF) — local departments of social services apply transfer-of-assets penalties for nursing facility coverage; checked October 14, 2026
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.
Common questions
Short answers to what people ask before they call.
Still have a question? Call (518) 902-8822 or book a call.
Does Medicare pay for a nursing home?
Only for a short-term stay that is skilled care: rehabilitation or skilled nursing after a qualifying hospital stay, in a Medicare-certified skilled nursing facility, for up to 100 days per benefit period. Medicare doesn't pay for a long-term nursing home stay when the care you need is custodial, such as help with bathing, dressing, eating or using the bathroom. Doctor visits and therapy you get while living in a nursing home are still covered under Part B.
How long does Medicare pay for skilled nursing?
Up to 100 days in each benefit period, as long as you still need and get daily skilled care. In 2026 days 1–20 cost $0 a day (the Part A deductible is usually already paid from the hospital stay), days 21–100 cost $217 a day, and from day 101 you pay all costs. Coverage can end before day 100 if the facility decides you no longer need daily skilled care; you can appeal that decision.
What is the three-day rule, and why does observation status matter?
To qualify for skilled nursing facility coverage you need a medically necessary inpatient hospital stay of at least three days in a row, counting the day you're admitted but not the day you leave. Time spent in the emergency room or under observation before you're admitted doesn't count, even if you stay overnight, because observation is outpatient care. If you're in the hospital more than 24 hours under observation, the hospital must give you a written notice (the Medicare Outpatient Observation Notice). Ask every day whether you're an inpatient or an outpatient.
Does Medicare cover assisted living?
No. Assisted living is long-term care, and Medicare doesn't pay for long-term care or room and board in an assisted living facility. Medicare still covers your doctor visits, therapy and other Part B services while you live there, and hospice care can be received there.
Who pays for long-term care in New York?
Medicare and Medigap don't. The three ways it gets paid are New York Medicaid for people who qualify on income and assets, a long-term care insurance policy bought in advance, or your own money. Nursing home Medicaid is decided by your county's Department of Social Services, and it looks back at gifts and transfers of assets made before you apply; a transfer for less than fair value can delay coverage. An elder-law attorney is the right person for planning around those rules.
Does Medigap pay the nursing home coinsurance?
For a covered skilled nursing stay, most Medigap plans pay the days 21–100 daily coinsurance in full; Plans A and B don't pay it, Plan K pays 50% and Plan L pays 75%. No Medigap plan pays for long-term custodial care or for days after day 100.
Does Medicare pay for hospice in a nursing home?
Medicare covers hospice care if you live in a nursing home and qualify (a doctor certifies a life expectancy of six months or less and you choose comfort care). It doesn't cover room and board in the nursing home, so that cost stays with you, Medicaid or other coverage. Short inpatient or respite stays arranged by the hospice team are covered.
A parent heading into rehab, or into a nursing home?
Tell me what the hospital has said and what coverage your family member has. I'll go through what Medicare will pay, for how long, and what happens on day 101.