Does Medicare Cover Nursing Home Care? (2026)

The 4 Requirements to Get Medicare SNF Coverage

Medicare will only pay for skilled nursing facility care when all four of the following conditions are met. (Medicaid covers long-term nursing home care for those who qualify financially.) Missing any single condition means Medicare will not cover the stay.

• You had a qualifying inpatient hospital stay of at least 3 consecutive days (not counting the discharge day), admitted as an inpatient — NOT on observation status.
• You were admitted to a Medicare-certified skilled nursing facility within 30 days of leaving the hospital.
• A doctor certifies that you need skilled nursing or rehabilitation services (physical therapy, occupational therapy, speech therapy, IV medications, wound care) on a daily basis.
• You receive care in a Medicare-certified SNF. Not all nursing homes are Medicare-certified. Always verify before placement.

Observation Status: The Most Dangerous Trap

One of the most common reasons Medicare denies SNF coverage is observation status. If your hospital labels your stay as outpatient observation rather than inpatient admission, those days do NOT count toward the 3-day qualifying stay — even if you slept in a hospital bed for three nights.

The NOTICE Act (effective 2016) requires hospitals to notify you in writing if you are under observation status. If you receive this notice, ask your doctor to formally change your status to inpatient admission. If the hospital denies that request, you have the right to appeal. The cost difference can be enormous: patients denied SNF coverage who need long-term nursing home care must pay $7,000 to $10,000 or more per month entirely out of pocket until they spend down assets to qualify for Medicaid.

Skilled Care vs. Custodial Care: The Key Distinction

Medicare covers skilled care only. Understanding what counts as skilled versus custodial is essential.

Medicare Advantage and the 3-Day Rule Waiver

Many Medicare Advantage (Part C) plans have waived the 3-day qualifying hospital stay requirement for SNF coverage. This can be a significant benefit if you need SNF care after a short hospitalization or outpatient procedure. However, there are important catches.

• Prior authorization is almost always required before or immediately after SNF admission.
• You must use an in-network SNF. Using an out-of-network facility can result in full denial of coverage.
• Plans can require shorter benefit periods or different cost-sharing than Original Medicare.
• Dual-eligible beneficiaries enrolled in D-SNP (Dual-Eligible Special Needs Plans) get coordinated Medicare and Medicaid benefits, which can eliminate most cost-sharing for SNF stays.

When Medicare Coverage Ends: The Medicaid Bridge

After day 100, or when skilled care is no longer needed, Medicare coverage for nursing home care ends completely. At that point, most people face one of three paths: private pay (at $7,000 to $10,000 or more per month), long-term care insurance (if purchased before the need arose), or Medicaid.

Nursing home care for people aged 21 and older is a mandatory Medicaid benefit in all 50 states. To qualify for Medicaid nursing home coverage, applicants must meet both income limits and asset limits set by their state. In 2026, a single Medicaid nursing home applicant typically must have income below $2,982 per month and countable assets below $2,000. See Medicaid income limits for the full breakdown by state. A community spouse (the spouse who remains at home) may retain up to $157,920 in assets. Medicaid eligibility rules vary significantly by state and are administered separately from Medicare — use our screener to check eligibility.

Medigap and SNF Coverage

If you have Original Medicare, a Medigap (Medicare Supplement) plan can cover the $217 per day coinsurance for SNF days 21 through 100. Medigap plans C, D, F, G, M, and N all include SNF coinsurance coverage. Plan F covers the Part A deductible as well, but Plan F is only available if you were eligible for Medicare before January 1, 2020. Plans K and L cover a percentage of the SNF coinsurance. No Medigap plan covers custodial nursing home care — that coverage gap remains regardless of which supplement you carry.

Does Medicare pay for nursing home care?

Medicare pays only for short-term skilled nursing facility care, up to 100 days per benefit period, after a qualifying 3-day hospital inpatient stay. Days 1 through 20 are covered at no cost to you (after the $1,736 Part A deductible). Days 21 through 100 require a $217 per day copayment in 2026. After day 100, Medicare pays nothing.

Does Medicare cover long-term nursing home care?

No. Medicare does not cover long-term custodial nursing home care, which includes ongoing help with bathing, dressing, eating, or toileting. This is the type of care that most nursing home residents need. Long-term custodial care costs $7,000 to $10,000 or more per month and is not covered by Medicare regardless of how long you have been on Medicare or how much you paid in.

What is the Medicare 3-day hospital stay rule?

To qualify for Medicare skilled nursing facility coverage, you must first have a formal inpatient hospital stay of at least 3 consecutive days. The day you leave the hospital does not count. Being kept for observation rather than admitted as an inpatient does NOT satisfy this rule, even if you were physically in a hospital bed for 3 nights. Always ask your doctor to confirm your status in writing.

How much does Medicare pay for a nursing home in 2026?

In 2026, Medicare covers days 1 through 20 of skilled nursing facility care at 100% after your $1,736 Part A deductible. For days 21 through 100, you pay $217 per day and Medicare covers the rest. After day 100, you pay 100% of all costs. These rates were published by CMS in November 2025 for calendar year 2026.

Does Medicare Advantage cover nursing home care?

Yes. Medicare Advantage (Part C) plans must cover SNF care at least as generously as Original Medicare. Many MA plans waive the 3-day qualifying hospital stay rule, which can be a real benefit. However, prior authorization is almost always required, and you must use an in-network facility. Your plan's cost-sharing may differ from Original Medicare's $217 per day coinsurance.

Who pays for nursing home care after Medicare runs out?

After Medicare's 100-day SNF benefit ends, you have three main options: private pay (paying out of pocket at $7,000 to $10,000 or more per month), long-term care insurance (if you purchased it before you needed care), or Medicaid. Medicaid covers long-term custodial nursing home care for people who meet income and asset requirements. It is the payer for roughly 60% of nursing home residents in the United States.

Does Medicaid cover nursing home care when Medicare won't?

Yes. Medicaid covers long-term custodial nursing home care as a mandatory benefit in all 50 states for eligible adults. To qualify in 2026, a single applicant typically must have income below $2,982 per month and countable assets below $2,000. A spouse remaining at home may keep up to $157,920 in assets. Unlike Medicare SNF coverage, there is no day limit — Medicaid covers nursing home care indefinitely for those who qualify.

What is the difference between a skilled nursing facility and a nursing home?

A skilled nursing facility (SNF) provides short-term, medically intensive care such as physical therapy, IV medications, or wound care, usually after a hospital stay. A nursing home typically refers to a facility providing long-term custodial care. Many facilities offer both levels of care in the same building — when Medicare covers your stay, you are technically in the SNF section. When Medicare coverage ends and you transition to custodial care in the same building, Medicare stops paying.