Does Medicare pay for a nursing home? What it covers in 2026
Key takeaways
- Medicare pays for short-term skilled care in a nursing home, up to 100 days in a benefit period. It does not pay for long-term custodial care.
- In 2026 you pay $0 a day for days 1 to 20 and $217 a day for days 21 to 100. After day 100 you pay all costs.
- You generally need a hospital stay of at least 3 days in a row as an admitted inpatient first. Time under observation does not count.
- If the home says your coverage is ending and you disagree, you can ask for a fast appeal.
Medicare pays for a nursing home stay only when it is short-term skilled care, usually rehab after a hospital stay. It covers up to 100 days in a benefit period. It does not pay for long-term care, which is what most people mean when they ask about "nursing home coverage."
What do you need to qualify?
Under Original Medicare, Part A covers care in a skilled nursing facility when all of these are true:
- You have Part A and have days left in your benefit period.
- You had a hospital stay of at least 3 days in a row as an admitted inpatient. The day you are admitted counts; the day you are discharged does not. Time in the emergency room or under observation before admission does not count.
- You enter the nursing home generally within 30 days of leaving the hospital.
- You need skilled nursing or therapy on a daily basis. If therapy is the only skilled care you need, at least 5 days a week counts as daily.
- The care is for a condition that was treated during the hospital stay, or for one that started while you were getting that care in the nursing home.
- The home is certified by Medicare. Each home's page on this site shows whether it participates in Medicare.
What do you pay in 2026?
| Days in the benefit period | You pay |
|---|---|
| Days 1 to 20 | $0 a day |
| Days 21 to 100 | $217 a day |
| Day 101 and after | All costs |
The Part A hospital deductible, $1,736 in 2026, applies to the benefit period and is normally paid during the hospital stay that comes first. At $217 a day, days 21 through 100 add up to as much as $17,360. Many Medicare Supplement (Medigap) plans pay some or all of that coinsurance.
What does Medicare cover during the stay?
A semi-private room, meals, skilled nursing care, physical, occupational and speech therapy, medical social services, medications, medical supplies and equipment used in the home, dietary counseling, and ambulance transportation to services the home cannot provide when other transportation would endanger your health.
Medicare does not cover custodial care when it is the only care you need. Custodial care is help with daily activities such as bathing, dressing, eating and using the bathroom.
Why can coverage end before day 100?
The 100 days are a maximum, not a guarantee. Coverage lasts only while you need daily skilled nursing or therapy. When the home decides that is no longer the case, it must give you a written Notice of Medicare Non-Coverage at least 2 days before covered services end.
How do you appeal if you disagree?
- Read the notice. It names an independent reviewer, the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), and gives its phone number.
- Call no later than noon on the day before the end date listed on the notice.
- The reviewer decides by the close of business on the day after it has the information it needs.
If the reviewer agrees that services are ending too soon, Medicare keeps covering the stay, apart from any coinsurance you owe.
What is a benefit period?
A benefit period starts the day you are admitted as an inpatient to a hospital or skilled nursing facility. It ends when you have gone 60 days in a row without inpatient hospital care or skilled care in a nursing home. After that, a new hospital stay of at least 3 days can start a new benefit period, with a new 100 days and a new Part A deductible.
What if you have a Medicare Advantage plan?
Medicare Advantage plans must cover the same services, but they set their own rules and costs. A plan may waive the 3-day hospital stay, require approval before the stay, limit you to homes in its network and charge different daily copays. Call the plan before you choose a home.
What happens when Medicare stops paying?
If your loved one still needs care, the stay becomes long-term care and someone else pays:
- Private pay. The 2025 national median is $9,581 a month for a semi-private room and $10,798 for a private room, according to the CareScout Cost of Care Survey. Prices vary widely by state, and CMS does not publish what each home charges.
- Medicaid. See how Medicaid pays for a nursing home.
- Long-term care insurance or veterans benefits, if your loved one has them.
Ask the home's social worker early whether it has a long-term bed and whether it takes Medicaid. See short-term rehab vs. long-term care.