Coverage
Nursing Home Care: The 100-Day Rule and What Comes After
Medicare pays generously for short-term skilled recovery and almost nothing for long-term residence. The difference is one word on an admission form.
Figures reviewed for 2026
By the SecureCare65 editorial team · Published October 27, 2026 · Reviewed for 2026 by a licensed agent
Medicare covers nursing facility care enthusiastically for a short window and almost not at all after it. The window is a hundred days, it requires a hospital admission first, and the word that separates the two outcomes is whether the care is skilled or custodial.
Skilled is covered, custodial is not
Skilled nursing facility care means daily skilled services from licensed professionals: intravenous medication, wound care, physical therapy after a stroke, monitoring for a condition that could destabilize. Medicare Part A pays for that, after a qualifying hospital stay, for up to one hundred days per benefit period.
Custodial care means help with eating, bathing, dressing, and supervision that keeps a person safe. It is the majority of what a long-term resident receives, and Medicare excludes it whether the building calls itself a nursing home, a rehabilitation center, or a care home.
The three-day admission that is not a formality
Original Medicare requires an inpatient hospital admission of at least three consecutive days, not counting the discharge day, before it will pay for skilled nursing. Time spent under observation status does not count, even when the person slept in a hospital bed and received hospital care.
This is the most expensive technicality in Medicare, and it is covered in its own article on this site. If a hospital stay might lead to a facility placement, ask on day one whether the status is inpatient or outpatient observation, and keep asking.
What the hundred days cost
For 2026, days one through twenty are fully paid by Part A. From day twenty-one through day one hundred, the patient owes coinsurance of $217 per day, and Medicare pays the rest. A Medigap policy with the skilled nursing benefit, which includes Plans G, F, and N, absorbs that daily amount. Medicare Advantage plans set their own structure but are required to match the traditional benefit overall.
After day one hundred, Part A stops. There is no extension for a person who still needs daily skilled care, and there is no appeal that converts custodial care into covered care.
What happens on day one hundred and one
Long-term placement is funded by Medicaid for people who qualify financially, by long-term care insurance if it was purchased years ago, by veterans benefits in some cases, or by private resources. A common pattern is a spouse spending down to Medicaid eligibility, which is a legal process best handled with an elder law attorney rather than guesswork.
One planning note matters more than any other here: Medicaid has a five-year look-back on asset transfers. Moving money to children during a crisis creates a penalty period. Moving it years earlier, with advice, does not. The cost of that advice is small next to the cost of getting it wrong.
The short version
Part A covers up to a hundred days of skilled care after a three-day inpatient stay, with $217 a day owed from day twenty-one. Custodial care beyond that is a Medicaid or private-pay question, so start the planning before the hospital, not after.
Official source
The federal guide behind this page
Medicare publishes its own handbook on this topic. It is linked here so you can check any figure on this page against the source.
- Your Discharge Planning ChecklistCMS 11376Read the PDFOrder print
- Your Guide to Choosing a Nursing HomeCMS 02174Read the PDFOrder print
- Your Guide to Living in a Nursing HomeCMS 12217
- Medicare Coverage of Skilled Nursing Facility CareCMS 10153Read the PDFOrder print
- Getting Started: Medicare & Skilled Nursing Facility CareCMS 11359Read the PDFOrder print
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Official sources
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