Medicare does not cover long-term custodial care in a nursing home. Custodial care means help with daily activities like bathing, dressing, eating, and using the bathroom, and it's the type of care most people need when they move into a nursing home permanently because of age, disability, or a chronic condition. Medicare was designed to cover medical treatment, not ongoing personal care, so if that's the only kind of help someone needs, Medicare will not pay for the room, board, or aides who provide it.
What Medicare does cover is short-term skilled nursing facility (SNF) care after a qualifying hospital stay. If you're admitted as an inpatient to a hospital for at least three consecutive days and then need skilled services like physical therapy, wound care, or IV medication administration, Medicare Part A can cover up to 100 days in a skilled nursing facility per benefit period. The first 20 days are covered in full, and days 21 through 100 require a daily coinsurance payment. After day 100, Medicare coverage stops completely, even if the person still needs skilled care.
It's important to understand that this SNF benefit is meant for rehabilitation and recovery, not permanent residence. Once a person plateaus and no longer needs daily skilled therapy or treatment, Medicare coverage ends, even if they still live in the facility and need help with daily activities. Many families are caught off guard when a loved one is discharged from Medicare coverage around day 20 or 21 because progress has leveled off, well before the 100-day maximum is reached.
Medicare Advantage plans follow similar rules, since they must cover at least what Original Medicare covers, though some plans offer additional short-term skilled nursing benefits or different cost-sharing structures. Either way, none of these plans turn into a long-term custodial care benefit.
Because Medicare leaves a major gap, most long-term nursing home care is paid for through one of a few sources: personal savings paid out of pocket, long-term care insurance purchased in advance, or Medicaid once a person's income and assets fall below their state's eligibility limits. Medicaid is actually the largest single payer of nursing home care in the United States, but it requires meeting strict financial thresholds, and many people have to spend down their savings before they qualify.
If you or a family member may need nursing home care in the future, it's worth planning ahead rather than assuming Medicare will handle it. Talking with an elder law attorney or a financial planner who specializes in long-term care can help you understand options like long-term care insurance, Medicaid planning, or setting aside funds specifically for this purpose. Starting this conversation before a crisis happens gives you far more choices than trying to figure it out during a hospital discharge.