When a loved one needs nursing home care, families may assume Medicare will cover the costs. However, Medicare Part A generally covers only short-term skilled nursing facility care that meets specific requirements. It does not cover long-term custodial care when that is the only care a person needs.
When does Medicare cover skilled nursing?
Original Medicare generally covers care in a skilled nursing facility after a qualifying hospital stay of at least three consecutive inpatient days. The admission day counts, but the discharge day does not. Time spent under observation does not count toward this requirement. Some Medicare Advantage plans and approved waivers may allow exceptions.
The patient must also need daily skilled nursing or therapy in a Medicare-certified facility and meet the other coverage requirements. A qualifying hospital stay alone does not guarantee coverage. Routine help with bathing, dressing or eating does not qualify on its own.
What costs does Medicare cover?
For eligible beneficiaries with Original Medicare, Part A can cover up to 100 days of skilled nursing facility care per benefit period. For days 1–20, there is no daily coinsurance after the $1,736 Part A deductible for 2026 is met. The deductible generally does not apply a second time to skilled nursing facility care if the patient already paid it for hospital care during the same benefit period.
For days 21–100, the daily coinsurance in 2026 is $217. After day 100, Medicare Part A no longer covers the stay under that benefit period.
A new benefit period generally starts when a person has gone 60 days without receiving inpatient hospital care or skilled nursing facility services. This can mean paying the Part A deductible again, even within the same calendar year. Simply leaving a facility does not reset the 100-day limit.
Why can Medicare coverage end before discharge?
Medicare may stop paying for a stay when a patient no longer needs qualifying skilled services or reaches the benefit limit. However, patients do not always have to keep improving for coverage to continue.
Medicare may cover skilled nursing or therapy needed to maintain a patient’s condition or prevent or slow deterioration, provided the other coverage requirements remain satisfied.
What should families do when Medicare coverage ends?
When Medicare no longer covers a skilled nursing facility stay, families may need to explore other ways to pay for ongoing care. Medicaid planning may help families evaluate options based on their financial circumstances and state rules. An elder-law attorney can explain which options may be available for their situation.
