Educational disclaimer. This is not Medicare.gov, not insurance advice, and not a plan recommendation. I am not a licensed insurance agent, not a Medicare counselor, and not SHIP. Savvy Senior Central is not affiliated with, endorsed by, or issued by CMS, SSA, HHS, or any state Medicaid agency. Official information: Medicare.gov or 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Free counseling: your State Health Insurance Assistance Program at shiphelp.org.
Medicare does not cover custodial care if that is the only care you need. Medicare.gov’s nursing-home page opens with that line. A nursing home can mean a short rehab stay after a hospital admission, or a long-term bed for help bathing, dressing, and eating. Those are different bills. Part A may cover the first, for a limited time, after a qualifying 3-day inpatient hospital stay. It does not pay the second.
People say “nursing home” for both. CMS does not. A skilled nursing facility (SNF) stay is skilled care in a Medicare-certified facility after a hospital admission. Assisted living room and board is custodial. See Does Medicare cover assisted living?.
This page does not invent a national average nursing-home price. Medicare.gov does not print one as a benefit.
I have spent 18 years inside consumer marketing and lead generation in insurance and health. That is operator experience, not a counseling credential and not a license.
Skilled care vs custodial care
Medicare.gov defines skilled care as nursing and therapy that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It is care to treat, manage, and observe your condition, and to evaluate your care.
Covered SNF services include a semi-private room, meals, skilled nursing, physical / occupational / speech therapy (when needed to meet your health goal), medical social services, medications, medical supplies and equipment used in the facility, ambulance when other transportation endangers your health, and dietary counseling.
Custodial care (also called long-term care or long-term services and support) is help with activities of daily living: bathing, dressing, eating, using the bathroom. Medicare.gov’s long-term-care page: Medicare doesn’t pay for long-term care. You pay all costs. You can get that care at home, in the community, in an assisted living facility, or in a nursing home.
Nursing homes can provide short-term rehab after surgery (hip or knee replacement) or skilled nursing to recover from an illness (pneumonia), or long-term custodial care. Medicare generally does not cover long-term nursing home stays unless you are receiving skilled nursing care.
If skilled care stops and you still need help getting dressed, that remaining stay is not a Part A SNF benefit.
The 3-day inpatient rule
Medicare covers SNF care only after a qualifying inpatient hospital stay: a prior medically necessary inpatient stay of at least 3 days in a row, starting the day you were admitted as an inpatient, not including the day you leave. Time under observation or in the emergency room before admission does not count, even overnight.
You generally must enter the SNF within a short time (generally 30 days) of leaving the hospital. A doctor must certify daily skilled care. The facility must be Medicare-certified. You need skilled services for an ongoing condition treated during the hospital stay (even if it was not the admission reason), or a new condition that started while you were getting SNF care for that ongoing condition. You need skilled nursing or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse.
You may not need a 3-day stay if your doctor participates in an Accountable Care Organization approved for a SNF 3-Day Rule Waiver. Medicare Advantage Plans may also waive it. Ask the hospital and, if you have Advantage, the plan.
You are an inpatient when the hospital formally admits you. Observation overnight is still outpatient. If you are under observation more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice (MOON). That notice is how you learn the 3-day clock did not start.
100 days per benefit period, not a lease
Part A limits SNF coverage to 100 days in each benefit period. A benefit period begins the day you are admitted as an inpatient in a hospital or SNF. It ends when you have not gotten any inpatient hospital care, or skilled care in a SNF, for 60 days in a row. There is no limit on the number of benefit periods. You can face another deductible later in the same calendar year.
Days 101 and beyond: you pay all costs.
What SNF cost sharing is in 2026
CMS fact sheet, November 14, 2025, restated on Medicare.gov’s SNF page and in publication 11579:
- Days 1-20: $0 each day after you pay the $1,736 Part A deductible. You do not pay that deductible again for SNF care if you already paid it for hospital care in the same benefit period.
- Days 21-100: $217 each day.
- Days 101 and beyond: you pay all costs.
If you are in a Medicare Advantage Plan, you may be charged copays during the first 20 days. Check the plan. Advantage must cover a qualifying SNF stay as a medically necessary Part A service, but the copay schedule follows the plan, not necessarily $0 / $217. Hospice is still billed to Original Medicare.
There is no yearly out-of-pocket maximum on Original Medicare alone. Medigap letters that cover SNF coinsurance (including G and N) can pick up the $217 days; see Plan G vs Plan N. Medigap generally does not cover long-term custodial care.
Part B still covers doctor visits and physical, speech, or occupational therapy even if you get those services in a nursing home, after the $283 Part B deductible, usually 20% of the approved amount if the provider accepts assignment. That is a doctor bill, not room and board.
Who pays for long-term nursing home care
Medicare.gov: Medicare generally doesn’t cover long-term care in a nursing home. Even then, you still need Medicare for hospital care, doctor’s services, drugs, and medical supplies while you are there. Most people who enter nursing homes start by paying out of pocket.
Medicaid is the primary national payer for long-term care. Medicaid.gov: Medicaid is the primary payer for long-term services and supports in institutions and through home- and community-based services. Eligibility is state-specific. Medicare.gov: most, but not all, nursing homes accept Medicaid. Many states have higher Medicaid income limits for nursing home residents. You may qualify for Medicaid in a nursing home even if you did not qualify for other Medicaid services before. Contact your state Medicaid office. This page does not invent a spend-down dollar amount.
If you have both Medicare and full-benefit Medicaid, and you do not choose an Advantage plan with drugs or a drug plan, Medicare will automatically enroll you in one. If you live in a nursing home and have full-benefit Medicaid, you pay nothing for covered drugs after Medicaid has paid for your stay for at least one full calendar month.
Long-term care insurance is a private policy. Medicare.gov: it can help pay for skilled and non-skilled care; coverage varies; buy from a company licensed in your state. This page does not rank those policies.
ACL.gov notes that people are often misinformed about what Medicare covers for long-term care. Eldercare Locator: 1-800-677-1116. That is a federal starting point, not a price list.
Advantage, I-SNPs, and quality ratings
If you have Advantage, check whether the nursing home has a contract with the plan. Medicare.gov: usually plans don’t help pay for this care unless the nursing home has a contract with the plan. Ask the plan. Institutional SNPs are Advantage plans for people who live in or need the level of care of a facility. They are not a custodial-care benefit.
Medicare.gov tells you to check the facility’s quality ratings before you enter. That is a consumer step. This page will not reprint a star table or name facilities.
What happens if skilled care stops, or you leave and come back
Coverage is tied to daily skilled care in a benefit period, not to the building’s name. If you no longer need daily skilled nursing or therapy, Part A SNF days stop even if you still live in the same nursing home. The bed can become a custodial bed.
If you are readmitted to the hospital from a SNF, ask whether a new qualifying stay starts a new SNF stretch inside the same benefit period or a new period. The 60-day break rule in Part A is the definition. Observation again will not count.
If the hospital changed your status from inpatient to outpatient observation, Medicare.gov notes you may be able to appeal denials of Part A inpatient coverage for stays back to January 2009. That is an appeal path, not a promise. If you do not have a 3-day stay, ask about home health or Medicaid. Medicare does not pay 24-hour care at home or custodial care when that is the only care you need.
Confirm before you sign an admission contract
Ask the hospital whether you were admitted as an inpatient and whether the 3-day rule is met. Ask the SNF whether it is Medicare-certified. Ask Medicaid about long-term stays. Start at Medicare.gov nursing-home and SNF pages, Medicaid.gov LTSS, and shiphelp.org. Do not use a marketplace quote as a CMS figure.
FAQ
Does Medicare pay for a long-term nursing home stay?
Generally no, if the only care you need is custodial. Medicare may cover a short-term skilled stay after a qualifying 3-day inpatient hospital admission, up to 100 days per benefit period.
Do observation nights count toward the 3 days?
No. Observation and emergency-room time before inpatient admission do not count, even overnight.
What is the 2026 SNF coinsurance?
Days 1-20: $0 (you may already have paid the $1,736 hospital deductible in the same benefit period). Days 21-100: $217 per day. After day 100: you pay all costs. Advantage copays can differ.
Does Medicare pay assisted living instead?
No. See Does Medicare cover assisted living?. Room and board there is not Part A.
Who pays if Medicare will not?
Most people start out of pocket. Medicaid is the primary national payer for long-term nursing home care if you qualify under state rules. Private long-term care insurance is a separate product. This page does not invent a national daily rate.
Does Part B pay the nursing-home room?
No. Part B may pay doctors and therapy in the facility. Room and board for a custodial stay is not Part B. Part A SNF room-and-board is only during a covered skilled stay.
About the author
Keith Guirao is founder and editor of Savvy Senior Central (Maven Media). He has spent about 18 years in consumer marketing and lead generation across insurance and health. That is operator experience, not a license to sell insurance, counsel Medicare, practice medicine, or give financial advice. Contact and bio: About · LinkedIn · Contact.
Disclaimer
Savvy Senior Central is not a licensed insurance agency. This article is for general educational purposes only and is not insurance, Medicare, legal, or clinical advice. Confirm the current rule with Medicare.gov, 1-800-MEDICARE, your plan’s Evidence of Coverage if you have Advantage, the facility, your state Medicaid agency, or SHIP. Costs and rules can change after CMS prints them.
Sources
Every figure traces to a government record. We do not cite insurance marketplaces for data. Figures last verified September 25, 2026 (ET).
- Medicare.gov: Nursing home care
- Medicare.gov: Skilled nursing facility care
- Medicare.gov: Long-term care
- Medicare.gov: How can I pay for nursing home care?
- CMS: 2026 Medicare Parts A & B Premiums and Deductibles (Nov. 14, 2025)
- Medicare.gov: 2026 Medicare costs (publication 11579)
- Medicare.gov: Medicare & You 2026 (publication 10050)
- Medicare.gov: Home health services
- Medicaid.gov: Long Term Services & Supports
- Administration for Community Living: What is Long-Term Care
- ACL: Eldercare Locator (1-800-677-1116)
- shiphelp.org: State Health Insurance Assistance Programs