Does Medicare cover long-term care or a nursing home?
Short answer
No. Medicare does not pay for long-term care. It does not pay for a permanent nursing home placement, for assisted living, or for help with bathing, dressing, eating, moving about and using the toilet when that is the only care needed. That kind of help is called custodial care, and Medicare excludes it however long it is needed and however genuinely it is needed.
What Medicare does cover is short-term skilled care after a hospital stay. Up to 100 days in a skilled nursing facility per benefit period, and only if you were admitted to hospital as an inpatient for at least three consecutive days first, and only for as long as you need daily skilled nursing or therapy. In 2026 days 1–20 have no coinsurance and days 21–100 cost $217 a day. After day 100, Medicare pays nothing.
Long-term care is mostly paid for privately or by Medicaid. Medicaid is the largest payer for nursing home care in the United States, but it is a means-tested programme with income and asset limits, a look-back period on gifts and transfers, and estate recovery afterwards. Long-term care insurance, personal savings, and in some cases VA benefits or a PACE programme make up the rest.
The distinction the whole question turns on
Almost every misunderstanding here comes from one place: Medicare pays for skilled care, not custodial care. The setting does not decide it. The same nursing home bed can be covered one week and not the next, because what changed is the kind of care being given.
| Skilled care | Custodial care | |
|---|---|---|
| What it is | Care that must be given or supervised by licensed professionals — wound care, IV medication, injections, physical or occupational therapy, rehabilitation after a stroke or a fracture. | Help with everyday activities — bathing, dressing, eating, using the toilet, moving from bed to chair, supervision for safety or memory loss. |
| Covered by Medicare? | Yes, under conditions, and for a limited time. | No, when it is the only care needed — regardless of how necessary it is or how long it goes on. |
| Typical duration | Days to weeks, while you are recovering. | Months to years. |
| Who usually pays | Medicare, then you or a supplement for the coinsurance. | You, long-term care insurance, or Medicaid once you qualify financially. |
What Medicare does cover, precisely
Skilled nursing facility care
Medicare Part A covers a stay in a Medicare-certified skilled nursing facility when all of the following apply:
- You had a qualifying inpatient hospital stay of at least three consecutive days. The day of discharge does not count. Time spent under observation does not count either — see below.
- You enter the facility within a short period of leaving hospital, generally 30 days.
- A doctor certifies that you need daily skilled nursing or skilled therapy for a condition treated during that hospital stay, or one that arose while you were being treated.
- The facility is certified by Medicare. Not all are, including some attached to hospitals you would expect to be.
What you pay in 2026, per benefit period:
- Days 1–20: nothing.
- Days 21–100: $217 a day.
- Day 101 onward: all costs.
The 100 days reset with each new benefit period, which begins once you have been out of a hospital and out of a skilled nursing facility for 60 consecutive days. They are not an annual allowance, and they are not a lifetime allowance.
Home health care
Medicare covers home health care when a doctor certifies that you are homebound and need intermittent skilled nursing care or skilled therapy, provided through a Medicare-certified agency. It covers part-time skilled nursing, physical, occupational and speech therapy, medical social services, and a home health aide — but the aide only while you are also receiving skilled care.
It does not cover 24-hour care at home, meals delivered to the house, homemaker services such as shopping and cleaning, or personal care as the only service you need. Those are the services most families are actually looking for, and they are the ones Medicare excludes.
Hospice
Medicare covers hospice care for someone certified as terminally ill with a life expectancy of six months or less who chooses comfort care over curative treatment. This is comprehensive — nursing, medication for symptom relief, equipment, counselling and respite care for the family. Note that hospice covers the care, not room and board in a nursing home, if that is where the person lives.
The observation-status trap
This is the most expensive detail on this page, and it catches thousands of families a year.
You can spend several nights in a hospital bed, in a hospital gown, being treated by hospital staff, and still be classified as an outpatient under observation rather than an inpatient. Observation time does not count toward the three-day inpatient requirement. If you are then discharged to a skilled nursing facility, Medicare will not pay for it, and the family discovers this on receiving the bill.
What has changed, and what to do:
- Hospitals must give you a written notice. The Medicare Outpatient Observation Notice, known as the MOON, must be provided to anyone under observation for more than 24 hours. CMS issued an updated version effective 21 April 2026. Read it, and ask directly: "Am I an inpatient or an outpatient under observation?" Ask on each day of the stay, because the answer can change.
- There is now an appeal right in some cases. Since 1 January 2025, people in Original Medicare whose status was changed from inpatient to observation during a stay can appeal that reclassification. This came out of long-running litigation and is not yet widely known, including among hospital staff.
- Medicare Advantage plans face a newer restriction. Under a 2026 rule, an Advantage plan may not retroactively reverse an inpatient admission it had already approved, except in cases of fraud or clear error.
- Some Medicare Advantage plans waive the three-day rule entirely. This is a genuine and underrated benefit of certain plans. If skilled nursing care is a realistic prospect for you, it is worth asking whether a plan waives the requirement before you enrol.
So who actually pays for long-term care?
- You do, at first, in most cases. Private pay from savings, a pension, or the proceeds of a house.
- Medicaid is the largest payer of nursing home care nationally. It covers custodial care that Medicare will not, but only once you meet your state's income and asset limits. Applications look back over transfers and gifts made in the previous five years in most states, and a gift inside that window can create a penalty period during which Medicaid will not pay. States also pursue estate recovery after death for long-term care costs paid on behalf of people aged 55 and over. Rules vary meaningfully by state — California, for example, has removed the asset limit that most states still apply.
- Long-term care insurance, if bought before you need it. Premiums rise steeply with age and health, and applications are underwritten, so this is a decision for the sixties rather than the eighties.
- VA benefits, including Aid and Attendance, for veterans and some surviving spouses who meet service and financial criteria.
- PACE — Programs of All-Inclusive Care for the Elderly — for people who need a nursing-home level of care but can live safely at home with support. Available only in some areas. Covered in more detail in our guide to Medicare on a fixed income.
- A Medicare Advantage plan's supplemental benefits may include limited in-home support, meals after a hospital stay, transport or bathroom safety equipment. These are real but modest, capped, and vary by plan. No Medicare Advantage plan covers ongoing custodial long-term care.
What to do about it
- If someone is in hospital now: ask every day whether they are an inpatient or under observation, get the answer in writing, and ask the discharge planner to confirm whether the stay will qualify for skilled nursing coverage.
- If a skilled nursing stay is ending: you have the right to a written notice and to a fast appeal if you believe skilled care is still needed. Appeals sometimes succeed, and they cost nothing to lodge.
- If you are planning ahead: speak to an elder law attorney about Medicaid rules in your state before making any gift or transfer of assets. The five-year look-back means well-intentioned transfers made too late can do real harm.
- If you are choosing a Medicare plan and this is on your mind: ask whether the plan waives the three-day inpatient requirement, and check its skilled nursing cost sharing and prior authorisation rules. Our comparison of HMO and PPO plans covers how those rules differ.
- Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased counselling. Every state has one, and it does not sell anything.
Where this information comes from
Coverage rules and cost-sharing amounts are set by the Centers for Medicare & Medicaid Services and change annually. The 2026 skilled nursing coinsurance of $217 a day is the official CMS figure. For the complete official position, including options we do not offer, see Medicare.gov on long-term care or call 1-800-MEDICARE.
Frequently asked questions
Does Medicare cover long-term care?
No. Medicare does not pay for long-term custodial care — help with bathing, dressing, eating, moving about and supervision — whether it is provided in a nursing home, an assisted living facility or at home. It covers short-term skilled nursing and therapy after a qualifying hospital stay, for up to 100 days per benefit period.
Does Medicare pay for a nursing home?
Only for a limited skilled stay, not for permanent residence. Medicare Part A covers up to 100 days in a Medicare-certified skilled nursing facility per benefit period, after an inpatient hospital stay of at least three consecutive days, and only while daily skilled nursing or therapy is needed. In 2026, days 1 to 20 cost nothing and days 21 to 100 cost $217 a day. After day 100 Medicare pays nothing.
How many days will Medicare pay for skilled nursing care?
Up to 100 days per benefit period, not per year. A new benefit period begins once you have been out of a hospital and out of a skilled nursing facility for 60 consecutive days, which restores the 100 days. Coverage can end sooner than 100 days if you no longer need daily skilled care.
What is the 3-day rule for Medicare skilled nursing coverage?
Medicare only covers a skilled nursing facility stay if it follows a hospital admission as an inpatient lasting at least three consecutive days, not counting the day of discharge. Time spent as an outpatient under observation does not count toward those three days, even if it involved overnight stays in a hospital bed. Some Medicare Advantage plans waive this requirement.
Why did my hospital stay not count toward the 3-day rule?
Most likely because you were classified as an outpatient under observation rather than admitted as an inpatient. Hospitals must give a written Medicare Outpatient Observation Notice, the MOON, to anyone under observation for more than 24 hours; an updated version took effect on 21 April 2026. Since 1 January 2025, people in Original Medicare whose status was changed from inpatient to observation during the stay have had a right to appeal that reclassification.
Does Medicare cover assisted living?
No. Medicare does not pay for room, board or personal care in an assisted living facility. It will still pay for covered medical services you receive while living there, such as doctor visits, hospital care or qualifying home health services, but not the cost of the facility itself.
Does Medicare cover in-home caregivers?
Only in a limited way. Medicare covers intermittent skilled nursing and therapy at home when a doctor certifies that you are homebound and need it, and a home health aide only while you are also receiving that skilled care. It does not cover 24-hour care at home, meal delivery, housekeeping, or personal care when that is the only help required.
Does Medicaid pay for nursing home care?
Yes, and it is the largest payer of nursing home care in the United States. Medicaid covers custodial long-term care that Medicare does not, but it is means-tested with income and asset limits that vary by state. Applications generally look back five years at gifts and asset transfers, and transfers within that window can create a period of ineligibility. States also pursue estate recovery after death for long-term care paid for people aged 55 and over.
Does a Medigap policy cover long-term care?
No. Medigap pays some or all of Original Medicare's cost sharing, which includes the skilled nursing facility coinsurance for days 21 to 100 under most plan letters. It does not extend coverage beyond what Medicare itself covers, so it pays nothing toward custodial long-term care.
Talk it through with a licensed agent
Whether a plan waives the three-day inpatient requirement, what it charges for skilled nursing care, and what in-home support it offers all differ from plan to plan. Tell us a little about yourself and a licensed insurance agent can go through the options available where you live. There is no cost and no obligation.
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Related guides
- How much does Medicare cost per month? — the deductibles and coinsurance behind these figures
- What is the cheapest Medicare plan on a fixed income? — Medicaid, Medicare Savings Programs, Extra Help and PACE
- Medicare Advantage vs Medigap — what a supplement does and does not extend
- Does Medicare cover dental, vision and hearing? — the other big coverage gap