Medicare does not pay for long-term nursing home care when the help you need is custodial care, like bathing, dressing and eating. Part A can cover short-term skilled nursing or rehab care, up to 100 days in each benefit period, after a qualifying inpatient hospital stay of at least 3 days in a row, with costs that rise after day 20. Long stays are usually paid by Medicaid, long-term care insurance or savings. Here is how the rules work and where families get caught off guard.
Does Medicare pay for a nursing home?
Only for a short skilled stay. Medicare.gov says Medicare generally doesn't cover long-term nursing home stays unless you're receiving skilled nursing care, and it doesn't cover custodial care if that is the only care you need. Custodial care is help with daily activities, the kind of care most people picture when they think of a nursing home.
What Part A can cover is a stay in a skilled nursing facility, usually after a hospital stay, while you recover from surgery, a stroke, a fall or a serious illness. The stay has to be medically necessary, and you have to need daily skilled care from nurses or therapists. Part B also keeps covering doctor visits and physical, speech or occupational therapy even while you live in a nursing home.
What are the rules for a Medicare-covered skilled nursing stay?
Medicare.gov lists the conditions for skilled nursing facility coverage. In plain terms, all of these have to be true:
- You had a medically necessary inpatient hospital stay of at least 3 days in a row.
- You have Part A and have days left in your benefit period.
- You enter the skilled nursing facility within a short time, generally 30 days, of leaving the hospital.
- Your provider has decided you need daily skilled care given by, or under the supervision of, skilled nursing or therapy staff.
- The facility is certified by Medicare.
- The skilled care is for a condition treated during the hospital stay, or a new condition that started while you were getting skilled care for it.
The hospital stay rule trips up a lot of families. Time spent under observation status in the hospital is outpatient care, even if you stayed overnight, and it doesn't count toward those inpatient days. If a parent is in the hospital, ask the staff directly whether they have been formally admitted as an inpatient.
How much does a skilled nursing stay cost with Medicare?
Under Original Medicare, the cost depends on how many days you have used in the benefit period. These are the current published amounts from CMS for 2026. CMS has not yet released the 2027 amounts; see Medicare.gov for the 2027 figures once they post.
| Days in the benefit period | What you pay in 2026 |
|---|---|
| Days 1 to 20 | $0 per day after the Part A hospital deductible of $1,736 |
| Days 21 to 100 | $217 per day |
| Day 101 and beyond | All costs |
Coverage also stops before day 100 if you no longer need daily skilled care. Once you only need custodial care, Medicare's payment ends even if you stay in the same building. Many Medicare Supplement plans help pay the daily coinsurance for days 21 to 100. Medicare Advantage plans set their own cost sharing and may charge copayments during the first 20 days, so check the plan's evidence of coverage.
Who pays for long-term nursing home care?
Medicare.gov is clear that Medicare and most other Health Insurance, including Medigap, don't pay for long-term care. That leaves three main ways people pay:
- Medicaid. Medicaid can pay for long-term nursing home care if you meet your state's income, asset and medical rules. It is the largest payer of long-term nursing home care in the country.
- Long-term care insurance. A private policy or a Life Insurance policy with a long-term care rider can pay toward care. It has to be bought while you are healthy enough to qualify. Our guide to long-term care insurance explains how it works.
- Your own savings. Many people pay privately at first and later qualify for Medicaid once their assets are spent down under state rules.
Does Medicare Advantage cover nursing home care?
Medicare Advantage plans must cover the same skilled nursing benefit as Original Medicare, but they can use networks and require prior authorization. Medicare.gov notes that plans usually don't help pay for nursing home care unless the nursing home has a contract with the plan. Some plans waive the 3-day hospital stay rule, which can help. If you or a parent might need rehab after a planned surgery, check which local facilities are in the plan's network before the surgery date.
For people with both Medicare and Medicaid, a Dual Eligible Special Needs Plan can coordinate Medicare's skilled care with Medicaid's long-term care benefits. That coordination matters when a short rehab stay turns into a long-term need.
How does this work in North Carolina, South Carolina and Tennessee?
The skilled nursing rules are federal, so Part A works the same in all three states. Long-term care is where your state matters, because each state runs its own Medicaid program. In North Carolina it is NC Medicaid. In South Carolina it is Healthy Connections Medicaid. In Tennessee, nursing facility care and many home and community services run through TennCare's CHOICES program. Each has its own eligibility rules and application process, so read your state's guidance or talk with us before assuming a parent does or doesn't qualify.
Our state pages on having Medicare and Medicaid at the same time explain how the two programs work together.
How The Jordan Insurance Agency can help
The nursing home question usually comes up in a hurry, after a fall or a hospital stay. We'll explain what Medicare will and won't pay, how your Medicare Supplement or Medicare Advantage plan handles a skilled nursing stay, and when it makes sense to look at long-term care coverage or Medicaid planning. If you're helping a parent, bring their Medicare card and plan information and we'll walk through it together. Schedule Your Consultation to review your options.
Reviewed by Billy Jordan Jr., licensed insurance agent · Licensing & Credentials · Last reviewed November 12, 2026 · Sources are linked in the answer above.
Licensing: Billy Jordan Jr. is licensed in 23 states, including North Carolina, South Carolina and Tennessee. See Licensing & Credentials.
Office: North Carolina and South Carolina clients are served by the Charlotte office, 3540 Toringdon Way, Suite 200, Charlotte, NC 28277, (704) 926-7565. Tennessee clients are served by the Nashville office, 159 4th Ave N, Suite 100, Nashville, TN 37219, (615) 558-6082.
Medicare disclaimer: We do not offer every plan available in your area. Currently we represent 8 organizations which offer 91 products in North Carolina, 7 organizations which offer 70 products in South Carolina, and 7 organizations which offer 65 products in Tennessee. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Read the full Medicare disclaimer.
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