Guide

Does Medicare pay for nursing homes? What's covered in 2026

Updated October 15, 2026 · Reviewed against official sources

Many families learn these rules all at once, on the day the hospital discharges their mom and someone mentions that "Medicare won't cover any more." Knowing them ahead of time helps you plan, ask the right questions and use your loved one's rights.

The key difference: skilled care vs. custodial care

• Skilled care: nursing or therapy that only a professional can provide or supervise. For example, wound care, injections or physical therapy after a fracture. Medicare does cover it for a limited time.
• Custodial care: daily help with bathing, dressing, eating, using the bathroom or moving around. Medicare doesn't cover it when it's the only need, whether at home, in assisted living or in a nursing home.

Most people who live in a nursing home for years mainly need custodial care. That's why they pay for it with their own savings or with Medicaid. See prices in how much senior living costs.

Skilled nursing facility (SNF): the 3-day rule

Medicare Part A covers a stay in a skilled nursing facility (SNF) if all of these conditions are met:

1. Your loved one was admitted to the hospital as an inpatient for at least 3 days in a row, by a doctor's order. The day of discharge doesn't count.
2. They need daily skilled care related to that hospital stay or to a condition that started while they were in the SNF.
3. They generally enter the SNF within 30 days after leaving the hospital, and the facility is Medicare-certified.
4. They have days left in their benefit period. The benefit period starts when they're admitted and ends after 60 days in a row without being an inpatient in a hospital or a SNF.

Inpatient or observation: a question worth asking. If your loved one is under observation status in the hospital, they count as an outpatient, even if they sleep several nights in a hospital bed. Those days don't count toward the 3-day rule, and neither does time in the emergency room. Kindly ask the team: "Is my mom admitted as an inpatient, or is she under observation?" When someone spends more than 24 hours under observation, the hospital must give them a written notice called the MOON (Medicare Outpatient Observation Notice).

SNF costs in 2026 (Original Medicare)

Before that, the hospital stay has a Part A deductible of $1,736 per benefit period in 2026. A supplemental insurance policy (Medigap) or Medicaid can pay the $217-a-day coinsurance.

Important: the 100 days are a maximum, not a guarantee. If your loved one no longer needs daily skilled care and only needs custodial care, Medicare may stop paying sooner. The facility must tell you in writing, and you can appeal. It's a good time to ask for a care plan meeting with the team and talk about next steps.

Exceptions to the 3-day rule

• TEAM model (2026 to 2030): CMS is testing a model that waives the 3-day rule for some people with Original Medicare who have one of five surgeries: lower-extremity joint replacement (such as a hip or knee), surgical treatment of a hip or femur fracture, spinal fusion, coronary artery bypass or major bowel surgery. It only applies at participating hospitals.
• Doctor groups (ACOs): if your loved one's doctor is part of an Accountable Care Organization with a waiver of the 3-day rule, it may apply.
• Medicare Advantage: many plans don't require the 3 days (see below).

Ask the hospital or the plan whether any of these exceptions apply in your case.

If you disagree: how to appeal

• Hospital discharge: when your loved one is admitted, the hospital must give you the "Important Message from Medicare" notice. If you think the discharge is too soon, you can ask for a fast appeal from your region's quality improvement organization (BFCC-QIO). The phone number is on that notice.
• Change from inpatient to observation: if your loved one has Original Medicare, was admitted and then the hospital changed them to observation, you can ask for a fast appeal while they're still in the hospital. The hospital gives you a notice called the Medicare Change of Status Notice. The special deadline to appeal past stays of this kind (the Alexander v. Azar case) ended on January 2, 2026; after that date, these appeals are only accepted with good cause.
• End of SNF coverage: the facility must give you a notice of non-coverage at least two days in advance. You can ask for a fast appeal.

See all the steps in the hospital discharge guide, on our urgent help page and in the guide about the hospital social worker, who usually coordinates the move to the SNF.

Home health care

Medicare pays for nursing visits, physical, occupational or speech therapy, and sometimes a home health aide, if:

• Your loved one is homebound: leaving home takes a great deal of effort.
• A doctor orders the care, and there's a plan of care.
• They need intermittent or part-time skilled care.
• The agency is Medicare-certified.

With Original Medicare, you usually pay $0 for these services (durable medical equipment has 20% coinsurance). It doesn't cover 24-hour care, home-delivered meals or a caregiver just for bathing or cleaning. Look for agencies in our home health agency directory and read the guide to home care for seniors.

Hospice

Hospice is for a person with a terminal illness and a prognosis of 6 months or less who chooses comfort care instead of treatment to cure the illness. It covers pain control, nursing care, aides, equipment, medications for symptoms, emotional support for the family and short-term respite care for the caregiver.

It doesn't cover room and board if the person lives in a nursing home or another care home. Read hospice and palliative care and look for providers in our hospice directory.

What Medicare doesn't pay for

• Long-term custodial care in a nursing home.
• Assisted living, board and care and memory care (neither the rent nor the care).
• In-home caregivers just for personal care or housework.
• Adult day centers (except through programs like PACE).

Medicare Advantage

Medicare Advantage plans (Part C) are private insurance plans approved by Medicare. They must cover everything Original Medicare covers, but they can have different rules:

• Many plans don't require the 3-day rule for a SNF.
• They may require prior authorization and use a network of facilities.
• SNF copays may be different from $217 a day.

Call the plan before discharge and ask, in writing, which facilities are in the network and how much you'll pay. The appeal for a change to observation described above is for Original Medicare; plans have their own appeal process.

Help paying Medicare costs

If your loved one has a low income, ask about Medicare Savings Programs (QMB, SLMB, QI), which are run by Medicaid, and about Extra Help for prescription drugs. For free, unbiased advice about their plan, find your state's SHIP program at shiphelp.org.

Medicare: 1-800-633-4227 (1-800-MEDICARE), 24 hours a day, with help in Spanish. TTY: 1-877-486-2048.

💬Frequently asked questions

Does Medicare pay for assisted living?

No. It doesn't pay for the rent or the personal care. Some states help with the care part through Medicaid; see what assisted living is.

My dad already used 100 days in a SNF. Can he get them again?

Yes, if a new benefit period starts (after 60 days in a row without being an inpatient in a hospital or a SNF) and he meets the conditions again, including a new 3-day hospital stay.

Are a SNF and a nursing home the same place?

Often, yes: the same building has short-term rehab (skilled nursing) beds paid for by Medicare and long-term care beds paid for by the family or by Medicaid. What changes is the type of care and who pays.

How do I choose a good-quality SNF?

Compare Medicare star ratings, visit the place with our visit checklist and ask about the therapy they offer.

In summary

1. Medicare pays for short-term rehab, not a stay for the rest of someone's life.
2. Confirm whether your loved one is an inpatient or under observation.
3. If money won't be enough for the long term, start the Medicaid application as soon as possible.
4. Compare facilities in our directory or with the guided search.

Rules can vary depending on your plan and your state. This guide is for information only and is not medical or legal advice.

Sources

• CMS, 2026 Medicare Parts A & B Premiums and Deductibles: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles (accessed October 15, 2026)
• Medicare.gov, Skilled nursing facility care: https://www.medicare.gov/coverage/skilled-nursing-facility-care (accessed October 15, 2026)
• Medicare.gov, Home health services: https://www.medicare.gov/coverage/home-health-services (accessed October 15, 2026)
• Medicare.gov, Hospice care: https://www.medicare.gov/coverage/hospice-care (accessed October 15, 2026)
• Medicare.gov, Long-term care: https://www.medicare.gov/coverage/long-term-care (accessed October 15, 2026)
• Medicare.gov, Appeals: https://www.medicare.gov/providers-services/claims-appeals-complaints/appeals (accessed October 15, 2026)
• CMS, Hospital Appeals - Change of Inpatient Status (Alexander v. Azar): https://www.cms.gov/medicare/appeals-grievances/original-medicare-appeals/hospital-appeals-change-inpatient-status-alexander-v-azar (accessed October 15, 2026)
• CMS, MLN Matters MM14098, waiver of the 3-day rule in the TEAM model: https://www.cms.gov/files/document/mm14098-implementing-transforming-episode-accountability-model-skilled-nursing-facility-3-day-rule.pdf (accessed October 15, 2026)
• Medicare.gov, Medicare Savings Programs: https://www.medicare.gov/basics/costs/help/medicare-savings-programs (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

👉Keep reading

Does Medicaid pay for care?

Yes, Medicaid pays for a nursing home if your loved one qualifies. 2026 limits, the 5-year look-back, spouse protections, waivers and how to apply.

Hospital discharge

What to do when an older adult is discharged from the hospital: inpatient vs. observation, Medicare's 3-day rule, how to appeal and a 48-hour checklist.

How much care costs

Nursing home, assisted living, adult day care, and home care prices by state (CareScout 2025). What the rate includes, what's extra, and how to pay.

Hospice and palliative care

The difference between hospice and palliative care, who qualifies for Medicare hospice, what it covers, what you pay and how to choose a provider.