Does Medicare Cover Nursing Home Care? Long-Term Care Explained

Many people think Medicare covers long-term nursing home care. The truth is more complex. Knowing the difference could save you from surprise costs.

!A senior care facility, representing Medicare nursing home and skilled nursing coverage

The Short Answer

> About 54% of Medicare beneficiaries are in Medicare Advantage, where this care runs through the plan's network; the rest use Original Medicare, accepted by any participating provider nationwide. (Source: CMS / KFF, 2024.)

Medicare does NOT cover long-term custodial nursing home care. But Medicare does cover short-term skilled nursing facility (SNF) care. You must meet certain rules first.

What Medicare DOES Cover: Skilled Nursing Facility Care

Medicare Part A covers skilled nursing facility care when:

1. You have a qualifying hospital stay of at least 3 days in a row as an inpatient. An observation stay does not count. 2. You enter the SNF within 30 days of leaving the hospital 3. You need skilled care (nursing or therapy) each day 4. A doctor orders the care 5. The SNF is Medicare-certified

SNF Coverage Costs (2025)

• Days 1-20: $0 (Medicare pays 100%)
• Days 21-100: $204.50/day coinsurance
• Days 101+: You pay 100% (Medicare stops paying)

What's Covered in a SNF

• A semi-private room and meals
• Skilled nursing care
• Physical, occupational, and speech therapy
• Drugs the facility gives you
• Medical equipment and supplies
• Diet advice

Important: The Care Must Be Skilled

Medicare covers SNF stays only when you need skilled care. It does not cover just help with daily tasks. Once you no longer need skilled nursing or therapy, your coverage ends. This is true even if you have not used all 100 days.

What Medicare Does NOT Cover: Custodial Care

Custodial care is help with daily tasks. People also call it personal care or long-term care. It includes:

• Bathing and dressing
• Eating and making meals
• Toileting and incontinence care
• Walking and moving around
• Reminders to take your drugs

Medicare does not pay for custodial care. That holds true even in a nursing home. This is the care most people picture in a nursing home. It is also the most costly type of care.

The Cost of Long-Term Nursing Home Care

In Florida, nursing home care costs about:

• Semi-private room: $9,000-$10,000/month
• Private room: $10,000-$12,000/month

Without coverage, a year in a nursing home can cost $100,000 or more.

Options for Paying for Long-Term Care

Medicare does not cover long-term custodial care. So you need other ways to pay:

1. Medicaid

Medicaid does cover long-term nursing home care if you qualify by income. But:

• It has strict income and asset limits
• You may need to "spend down" your assets to qualify
• Your choice of facilities may be small
• Look-back rules apply when you transfer assets

2. Long-Term Care Insurance

Private long-term care insurance can cover:

• Nursing home care
• Assisted living
• Home health care
• Adult day care

Buy it before you need it, ideally in your 50s or early 60s. Premiums rise as you age. And health problems may make you ineligible.

3. Self-Pay

Many people pay out of pocket. They often:

• Use savings and investments
• Sell a home
• Get help from family
• Cash in life insurance policies

4. Veterans Benefits

If you are a veteran, you may qualify for:

• VA nursing home care
• Aid and Attendance pension benefits
• Community living centers

Medicare Advantage and Nursing Facility Care

Medicare Advantage plans must cover SNF care at least as well as Original Medicare. Some perks include:

• No 3-day stay rule (some plans waive it)
• Lower coinsurance than Original Medicare
• A yearly out-of-pocket max that caps your costs
• Care coordination to ease your move

Some Medicare Advantage Special Needs Plans (SNPs) are built just for people who live in nursing facilities.

Planning Ahead

The key to long-term care costs is to plan before you need care:

1. Know what Medicare covers (and what it does not) 2. Look at long-term care insurance while you are healthy 3. Learn the Medicaid rules in your state 4. Talk with family early 5. Meet with an elder law attorney for estate planning

Getting Help

Medicare, Medicaid, and long-term care can be hard to sort out. A licensed Medicare advisor can help you understand your options. They can also help you plan for the future.

Next steps: Take our 2-minute Medicare plan quiz, book a free Medicare review, or see our Medicare Advantage vs. Supplement comparison.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.