Serious Illness & Facility Care
Does Medicare Cover Nursing Home or Long-Term Care?
Mostly no. Medicare pays for short-term skilled nursing care after a qualifying hospital stay — up to 100 days — but not for long-term nursing home stays, which are custodial care. Medicaid is the usual payer for those.
What Original Medicare covers. Part A pays for short-term care in a skilled nursing facility (SNF) — nursing, physical therapy, wound care aimed at recovery — but only after a qualifying hospital stay of at least three days as an admitted inpatient. When you qualify, the first 20 days of each benefit period are fully covered; days 21 through 100 carry a significant daily coinsurance; after day 100, Medicare pays nothing.
What it does not cover. Long-term nursing home care. Most long stays are custodial care — help with bathing, dressing, eating, and toileting — and Medicare does not pay for custodial care when that is the only care you need, no matter where you receive it. This is the hard truth most families learn late, often in a hallway conversation with a discharge planner.
The conditions that trip people up. The three-day stay must be as an admitted inpatient — nights spent under "observation status" do not count, even in a hospital bed. Ask directly: "Am I admitted as an inpatient, or under observation?" And skilled coverage continues only while you actually need skilled care: once your care becomes custodial, Medicare stops paying even before day 100.
The honest cost note. The hospital stay that qualifies you starts with the $1,736 Part A deductible in 2026, and the SNF daily coinsurance from day 21 adds up quickly. A long-term stay after Medicare stops is paid by you, by long-term care insurance, or — for people who qualify — by Medicaid, which is the main payer of long-term nursing home care.
Medicare Advantage plans must cover the same skilled nursing benefit, and plan rules on the three-day-stay requirement can differ — check the plan's Evidence of Coverage rather than assuming either way.
Who to talk to. Talk to your doctor and the hospital discharge planner about whether the care being ordered is skilled care and whether your stay counts as inpatient. Talk to an advisor — or your state Medicaid office — about how a long-term stay would actually be paid for, before the need is urgent.