What Medicare Covers

Short-Term Only

Medicare covers nursing home care ONLY for short-term skilled nursing or rehabilitation after a hospital stay. It does NOT cover long-term care. This is the biggest misconception about Medicare.

Up to 100 Days

Medicare covers up to 100 days per benefit period—but only if you continue to need skilled nursing or therapy and are making progress.

Most People Don't Get 100 Days

The average Medicare nursing home stay is only 20-30 days. Medicare stops coverage when you stop improving, even if you haven't used all 100 days.

3-Day Hospital Stay

You must have a qualifying hospital stay of at least 3 days (3 midnights) as an admitted inpatient. Observation status doesn't count—make sure you're actually admitted.

Enter Within 30 Days

You must enter the nursing home within 30 days of leaving the hospital (though exceptions exist if there are delays).

Same or Related Condition

The nursing home care must be for the same condition (or related condition) that caused the hospital stay.

Need for Skilled Care

You must need daily skilled nursing care or therapy services. Just needing help with bathing, eating, or dressing (custodial care) doesn't qualify.

Doctor's Orders

A doctor must order the nursing home care and certify that you need skilled services.

Days 1-20: Fully Covered

Medicare pays 100% of the cost. You pay nothing (as long as the facility accepts Medicare).

Days 21-100: You Pay a Copay

You pay a daily copay (around $200/day as of 2024—this amount adjusts annually). Medicare pays the rest. A Medigap plan may cover this copay.

After Day 100: No Coverage

Medicare stops covering nursing home care entirely. You must pay privately, use Medicaid (if eligible), or go home.

Semi-Private Room

Medicare covers a semi-private room (shared with a roommate). If you want a private room, you pay the difference out-of-pocket.

Meals and Nursing Care

All meals, skilled nursing care, and medically necessary care are covered.

Therapy Services

Physical therapy, occupational therapy, and speech therapy are covered if medically necessary.

Medications and Supplies

Medications given in the facility, medical supplies, and equipment are covered.

What's NOT Covered

Medicare doesn't cover: private duty nurses, personal care items (toiletries, phone, TV), private rooms (unless medically necessary), or long-term custodial care.

Pre-Approval Isn't Required

You don't need Medicare's pre-approval to enter a nursing home. As long as you meet the requirements, Medicare should cover it.

Medicare Reviews Your Care

Medicare regularly reviews your case to make sure you still need skilled care. If you plateau or stop improving, they'll end coverage.

You Must Be Making Progress

Medicare requires that you're improving with therapy. If you're not getting better, they consider you "maintenance" (not skilled) and stop paying—even if you still need help.

If Medicare Denies Coverage

You have the right to appeal. The nursing home should give you a "Notice of Medicare Non-Coverage" (NOMNC). Don't leave without appealing—you may win.

You Have 3 Options

1) Go home (if possible). 2) Pay privately (out-of-pocket or insurance). 3) Apply for Medicaid (if eligible).

Plan Ahead

Don't wait until the last minute. If Medicare is about to stop, start planning early. Talk to the facility's social worker about your options.

Facilities Can't Force You Out Immediately

Nursing homes must give you at least 30 days' notice before discharging you. You have rights—contact your state ombudsman if they try to rush you out.

Observation Status Doesn't Count

If you were in the hospital under "observation" instead of admitted, Medicare won't cover the nursing home. Ask your doctor to admit you as an inpatient if you think you'll need skilled nursing after discharge.

Medicare Advantage Plans Have Different Rules

If you have Medicare Advantage (Part C), your plan may have different rules, require pre-authorization, or only cover certain nursing homes. Check with your plan before admission.

Skilled vs. Custodial Care

Medicare only covers "skilled" care (nursing, therapy). If you just need help with daily activities (bathing, dressing, eating), that's "custodial" care and Medicare won't pay.

Get Everything in Writing

Ask the nursing home for a written estimate of how long Medicare will cover you and what you'll owe. Don't assume they'll tell you when coverage is about to end.