The most common misconception about Medicare is that it covers long-term nursing home care. It does not. Medicare Part A covers short-term skilled nursing facility (SNF) stays under very specific conditions, and the coverage ends sharply at day 100.
What Medicare Part A Covers
The Three Qualifying Rules
Before Medicare will pay a single day in a SNF, three conditions must be met:
- 3-day inpatient hospital stay: you must be formally admitted as an inpatient (observation status does not count) for at least 3 consecutive days
- Medical necessity: the SNF stay must be for a condition treated during the hospital stay
- Skilled care required: you must need skilled nursing or therapy services (e.g., wound care, IV antibiotics, physical therapy). Custodial care alone doesn't qualify
What Medicare Does NOT Cover
- Long-term custodial care (help with bathing, dressing, eating)
- Nursing home stays beyond 100 days
- Most assisted living costs
- Most memory care costs
- Private room upgrades (unless medically necessary)
What Fills the Gap?
After day 100, families typically rely on Medicaid (for those who qualify based on income and assets), long-term care insurance purchased in advance, or private pay from personal savings. Medicare Supplement (Medigap) plans can cover the days 21–100 copayment, but not coverage beyond day 100.
Medicare Advantage Plans
Some Medicare Advantage (Part C) plans offer enhanced SNF benefits, including reduced copays, longer coverage periods, or some in-home benefit. Check your specific plan's Evidence of Coverage document carefully, as benefits vary widely.
Use CareScope to identify Medicare-certified skilled nursing facilities near you. Look for the "Medicare certified" filter in our search tool.