If you think it may be time to look into long-term or nursing home care, a major consideration will be cost. According to a 2025 report from Genworth, the median fee for a semi-private room in a nursing home in the United States is more than $9,000 a month. A private room is more than $10,000.
With these steep numbers in mind, it’s important to understand that Medicare won’t cover your stay in a nursing home. Instead, Medicare considers the care provided in nursing homes and many long-term care and assisted living facilities “custodial care.” Custodial services include assistance with things like bathing, dressing, and eating – help that doesn’t require a skilled medical professional.
Medicare does, however, cover some costs for skilled nursing facilities. This treatment is prescribed by your doctor, often after you’ve been in the hospital. It’s considered medically necessary to treat an illness or injury and is given by a healthcare professional or rehabilitative specialist.
Here’s what you should know about Medicare skilled nursing facility coverage, when Medicare pays, and how you can navigate the Medicare 100-day rule.
When does Medicare pay?
Medicare skilled nursing facility coverage kicks in after you’ve been in the hospital for three days from the time you were admitted (that doesn’t include time there for observation, like an overnight stay in the emergency room). This means, if you are there for just two days, you will be responsible for paying costs up to your deductible, which is $1,736 in 2026.
Medicare pays for skilled nursing costs if:
- You are enrolled in Medicare Part A (hospital insurance).
- Your doctor orders the care for something you were treated for at the hospital, even if it isn’t directly related to your admission. For instance, you are hospitalized for pneumonia, and your diabetes worsens during your stay, your doctor may feel you need time in skilled nursing to stabilize your blood sugar before returning home.
- You begin treatment within 30 days of your hospital discharge.
- You get care from a Medicare-certified facility.
- You have days left in your benefit period for skilled nursing care. This benefit period ends when you haven’t received care in a skilled nursing facility for 60 days in a row.
There are limited circumstances under which Medicare will pay for your skilled nursing care if you haven’t been in the hospital for three days. The Skilled Nursing Facility 3-Day Rule Waiver includes exceptions if your hospital is part of an Accountable Care Organization (ACO) or takes part in Medicare’s Transforming Episode Accountability Model (TEAM) model. You can ask your doctor or hospital staff to find out if they take part in either of these programs.
The 100-day rule
Medicare covers up to 100 days of skilled nursing care during each benefit period. During this time, it pays for things like:
- A shared room
- Meals
- Skilled nursing care
- Other treatments, including physical, occupational, and speech therapy
- Medications
- Medical equipment and supplies
But Medicare doesn’t pay all your costs, even during your first 100 days. What it pays depends on how long you’re receiving care. If you don’t have supplemental insurance to help cover your costs, here’s what that might look like:
- 1-20 days: You pay your Medicare nursing home co-insurance ($1,736 for 2026). After that, you pay $0 each day, and Medicare covers the costs.
- 21-100 days: You pay $217 per day.
- 101 days and beyond: You pay all the costs.
Your skilled nursing facility isn’t required to notify you of the length of time you’ve been treated. If you need long-term care, it will be important for you, your spouse, or a caregiver to track your length of stay to understand when you are near 100 days.
Paying for care
If you need long-term care, whether in a nursing home or skilled nursing facility, you can find yourself saddled with thousands of dollars of medical bills. Luckily, there are options aside from Medicare to help you cover some of those costs.
- Medicaid, health insurance for people with lower incomes and disabilities, pays for 100% of nursing home costs. Medicaid is administered by states, and each state has its own strict rules for eligibility and coverage. You can contact your state Medicaid office to see if you qualify.
- Veteran’s benefits pay for long-term care in U.S. Department of Veterans Affairs (VA) nursing homes and some non-VA facilities for people who served in the U.S. military. What the VA pays for nursing home care depends on your need, your service disability status, and your other insurance coverage. You can contact the VA for more information.
- Long-term care insurance typically covers the cost of a nursing home, but there is usually a waiting period of 30 to 90 days before your benefit is triggered. Contact your broker to find out about your specific plan.
- Your assets, including savings, Social Security income, and retirement, can be used to cover your expenses. Some people also consider a reverse mortgage, which turns your home equity into cash, to cover medical bills.
- Home health care is also an option if you have hit your 100 days in a skilled nursing facility and are able to partially care for yourself. Some home health care organizations offer skilled nursing care, and Medicare may pay for some of the costs.
The decision to live in a nursing home or other long-term care facility can be a challenging transition for you and your family. Planning ahead and understanding how you will pay for your care can help ease your mind and make things go more smoothly. Medicare supplemental policies can cover excess expenses and coinsurance for skilled nursing facilities, saving you thousands of dollars over time. Talk to your plan sponsor to find out what coverage you have on your plan.
