Medicare will pay for up to 100 days in a nursing home per benefit period, and only in a Medicare-certified skilled nursing facility. The first 20 days are fully covered. Days 21 through 100 carry a coinsurance of $217 per day in 2026. After day 100, Medicare pays nothing. And none of it applies unless you need skilled care after a qualifying hospital stay, which is where most families get tripped up long before they hit the day limit.
Skilled Care Is the Only Kind Medicare Pays For
Medicare Part A covers a nursing facility stay when you need hands-on medical or rehabilitative services that only trained professionals can safely provide. Think intravenous medications, wound care from a nurse, physical therapy after a hip replacement, or occupational therapy to relearn dressing and eating. During a covered stay, Part A also pays for your room, meals, medications tied to your treatment, and medical supplies.
What Medicare does not cover is custodial care, the help most people picture when they think of a nursing home: bathing, dressing, eating, using the bathroom, general supervision. When those services are the whole reason someone is in a facility, and no underlying skilled medical need is driving the care, Medicare will not pay a dollar. Someone with advanced dementia who needs round-the-clock supervision but no active medical treatment is receiving custodial care by Medicare’s definition, no matter how demanding that care is in practice.
The Three-Day Hospital Stay Comes First
Before Medicare pays for a single day in a skilled nursing facility, you need a qualifying inpatient hospital stay. A doctor must formally admit you as an inpatient, and you must spend at least three consecutive days in the hospital. The clock starts on the admission date and does not count the day you are discharged.
After leaving the hospital, you generally have 30 days to enter the skilled nursing facility. The care you receive there has to relate to the condition that put you in the hospital, or to a new condition that developed while you were already getting covered SNF care for the original problem.
Watch for Observation Status
This is where families lose coverage they thought they had. Time spent in the emergency room or under “observation status” does not count toward the three-day requirement, even if you sleep several nights in a hospital bed getting treatment. You can be in a hospital gown, in a hospital room, receiving hospital care, and still fail to qualify because you were never formally admitted as an inpatient.
Federal law requires hospitals to give you a written notice, the Medicare Outpatient Observation Notice, when you have been under observation for more than 24 hours. The notice explains your outpatient status and its consequences for skilled nursing facility coverage. If a nursing facility stay looks likely, ask directly whether the admission is inpatient or observation. Getting this wrong can mean tens of thousands of dollars in uncovered bills.
How the 100 Days Are Counted
Medicare measures skilled nursing coverage in benefit periods. A benefit period begins the day you are admitted as an inpatient to a hospital or skilled nursing facility. It ends only after you go 60 consecutive days without receiving any inpatient hospital or skilled nursing care.
Within a single benefit period, Part A covers up to 100 days of SNF care. If you leave the facility and return within 30 days, your stay picks up where it left off, no new three-day hospital stay required. You keep counting from the day you left.
Once a benefit period ends after that 60-day break, a new one can begin. If you later need another qualifying hospital stay and meet all the eligibility rules again, you get a fresh 100-day benefit. There is no lifetime cap on how many benefit periods you can use.
What You Pay in 2026
The cost structure has three tiers, and the jump between them is steep.
- Days 1 through 20: $0 in coinsurance. Medicare covers the full cost of approved services. If you already paid the Part A inpatient deductible ($1,736 in 2026) during your qualifying hospital stay, you do not pay it again for the SNF portion of the same benefit period.
- Days 21 through 100: $217 per day in coinsurance. Over the full 80-day stretch, that is $17,360 out of pocket.
- Days 101 and beyond: Medicare pays nothing. The full cost is yours.
Those figures apply to Original Medicare. If you have a Medicare Supplement (Medigap) policy, several plan letters cover some or all of the day 21–100 coinsurance; Plans C, D, F, G, M, and N generally cover the full daily amount, Plan K covers 50%, and Plan L covers 75%. Plans A and B do not cover SNF coinsurance. Check which letter you own before assuming you owe $217 a day.
Medicare Advantage Works a Little Differently
Medicare Advantage plans (Part C) must cover at least everything Original Medicare covers, but they can structure the rules differently. Many Medicare Advantage plans waive the three-day prior hospital stay requirement for SNF admission, which can matter enormously if your hospital stay was too short or was classified as observation.
The trade-off is that these plans often require you to use in-network facilities, and their daily cost-sharing may not match Original Medicare’s. If you are enrolled in a Medicare Advantage plan, contact the plan directly to confirm the SNF benefit details before admission rather than assuming the standard rules apply.
You Do Not Have to Be Improving to Keep Coverage
Families are often told Medicare will stop paying because the patient “has plateaued” or “is no longer improving.” For years, many providers applied an unofficial improvement standard and cut off coverage once progress stalled. The Jimmo settlement, approved in 2013, clarified that Medicare covers skilled nursing and therapy services when they are needed to maintain your current condition or to prevent or slow further decline, not only when you are expected to improve.
The right question is whether the care requires the skills of a trained professional to be delivered safely and effectively, not whether you are making measurable progress. If a physical therapist’s expertise is necessary to carry out a maintenance program that keeps you from losing mobility, that care can qualify. “You’re not improving” is not, on its own, a valid basis for denial.
If the Facility Says Coverage Is Ending
When a skilled nursing facility decides your Medicare-covered care is ending, it must give you a written Notice of Medicare Non-Coverage at least two days before covered services stop. You have the right to a fast appeal through the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) listed on the notice, and the deadline is unforgiving: you have to contact the BFCC-QIO no later than noon the day before the stated termination date.
While the review is pending, you generally are not responsible for the costs of the disputed care, and the BFCC-QIO decides quickly. Miss the noon deadline, though, and you lose that protection against being charged. If a discharge notice lands, act on it the same day rather than waiting to work through the paperwork.
What Pays After Medicare Stops
Once you use up the 100 days or no longer meet the skilled care requirement, the financial picture changes fast. The national median cost of a semi-private nursing home room runs roughly $315 per day, or about $115,000 per year. Private rooms cost more, and the numbers vary widely by state.
Medicaid is the primary payer for long-term nursing home care in the United States and covers more residents than any other source. Unlike Medicare, Medicaid does pay for custodial care. Eligibility is based on income and assets, thresholds vary by state, and most states require you to spend down resources to very low levels before qualifying. Many families begin the Medicaid application well before Medicare coverage runs out.
Long-term care insurance, if purchased before care was needed, can also cover nursing home costs, subject to waiting periods (often 30 to 90 days) and daily benefit caps. It is not an option you can add after the fact. For care that can be delivered at home, Medicare’s home health benefit covers part-time skilled nursing or therapy for people who are homebound, and it does not require a prior three-day hospital stay.
The Numbers at a Glance for 2026
- Maximum covered days: 100 per benefit period
- Qualifying hospital stay: 3 consecutive inpatient days; observation time does not count
- SNF admission deadline after discharge: 30 days
- Days 1–20 coinsurance: $0
- Days 21–100 coinsurance: $217 per day ($17,360 if you use all 80 days)
- Part A inpatient deductible: $1,736 per benefit period, not charged again for SNF if already paid during the hospital stay in the same period
- Benefit period reset: 60 consecutive days without inpatient hospital or SNF care